RECAP 

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A.  CORBETT-SMITH 


^AtUvmtt  BItbrarg 


THE   PROBLEM   OF   THE    NATIONS 


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The  Problem  of  the  Nations 

A  Study  in  the  Causes,  Symptoms  and  Effects  of  Sexual 
Disease,   and   the  Education  of  the  Individual  therein 


BY 

A.    CORBETT- SMITH 

M.A.Oxon.  ;    Barrhter-at-Law  ;    Captain   {for7nerly  R.F.A.)  ;    F.R.G.S.  ;  "  Officier  de 

I'lnsirticiion  Ptcbliqtie";  Editor  of  ^'  The  Journal  of  State  Medicine"  ;  Lecturer 

in  Public  Health  Law  at  the  Royal  histitute  of  Public  Health 


"  The  heart  of  England  is  not  callous  to  the  sufferings  of  her  children.  Men  upon 
these  subjects  are  for  the  most  part  either  indolent  or  ignorant.  They  do  not  think  about 
them  ;  they  do  not  know  about  them,  and  they  turn  away  from  them  as  they  turn  away 
from  other  unpleasant  subjects,  not  with  a  cynical,  callous,  determined  dislike,  but  simply 
with  unawakened  sympathy.  But  once  let  the  heart  of  England  be  really  aroused,  let  the 
conscience  of  this  country  be  really  excited,  then  I  do  not  believe  for  a  moment  that  there 
will  be  any  lack  of  workers  in  the  cause,  or  any  lack  of  enthusiasm  for  the  great  objects 
which  that  cause  undertakes."— ZOi?/)  COLERIDGE  (a  Lord  Chief  Justice  of  England). 


NEW  YORK 
PAUL   B.    HOEBER 
67-69,   East   59TH   Street 

1914 


LONDON  ; 

JOHN    BALE,    SONS   AND   DANIELSSON.    LTD. 

OXFORD   HOUSE 

83-91,   GREAT  TITCHFIELD  STREET,   W. 


DEDICATION. 


This  little  book  has  been  written,  or  rather  compiled, 

FOR    ALL    YOUNG    MEN    UPON    THE   THRESHOLD 

OF    LIFE. 

THEIR    MOTHERS    AND    FATHERS, 

FOR 

ALL    MEN    AND    WOMEN    WHO    HOPE    SOME    DAY    TO 
BE    IN    THE   SAME    PROUD    POSITION. 


A/ 

/9/f 


Vll 


FOREWORD. 

This  is  not  a  Scientific  Treatise.  It  is,  or  at  least  I  hope 
it  will  be  found  to  be,  a  plain,  straightforward  account  of  the 
greatest  curse  known  to  civilization  ;  a  plague  which  is  indeed  the 
Problem  of  the  Nations.  I  have  tried  to  write  the  account  in  such 
a  fashion  that  all  may  understand.  Some  technical  terms  there 
must  be,  but  in  writing  about  intimate  details  of  sex  there  is  only 
one  language  which  can,  with  proper  decency,  be  employed,  and 
that  is  the  language  of  medical  science.  In  any  case  there  will  be 
found  a  short  glossary  at  the  end  of  the'^book  which  may  prove 
useful. 

I  am  not  a  medical  man.  If  I  were  I  probably  could  not  have 
tackled  the  subject  from  this  independent  point  of  view.  My  out- 
look would,  I  feel,  have  been  prejudiced.  I  have  the  deepest  respect 
and  admiration  for  the  medical  profession.  I  am  told  that  the  first 
man  my  eyes  ever  looked  upon  was  a  doctor,  and  I  have  been  most 
intimately  associated  with  the  profession  ever  since. 

But,  with  all  due  respect  to  its  members,  I  cannot  help  thinking 
that  those  who  specialize  in  a  subject  such  as  Sexual  Disease  are  too 
prone  to  work  with  their  eyes  glued  to  the  microscope.  They 
discover  and  record  details  with  the  utmost  nicety  of  precision ;  they 
cannot  always  grasp  the  subject  in  its  entirety,  the  big  human  side 
of  it.  Those  who  do  not  specialize  must  needs  possess  a  good 
working  knowledge  of  the  subject,  but  they  must  also  give  an  equal 
share  of  attention  to  half  a  hundred  other  departments  of  their 
work.     They  have  not  the  time  nor  opportunity  to  go  into  details. 

My  own  methods  of  investigation  have  been  perfectly  simple. 
In  fact  it  has  been  so  easy  that  I  never  cease  to  wonder  why  in 
this  country  it  has  not  been  done  years  ago.  There  is  no  doubt 
whatever  that  it  should  have  been  done ;  nor  should  it  have  been 
left  for  a  layman  to  take  it  up,  almost  by  pure  accident.  Certainly, 
I  have  had  exceptional  facilities  for  acquiring  information,  and  for 
these  I  must  record  my  indebtedness  to  my  connection  with  The 
Koyal  Institute  of  PubHc  Health. 


Vm  THE   PROBLEM   OF   THE   NATIONS 

That  kej'  has  unlocked  the  doors  of  official  statistical  bureaux  and 
Ministries  of  Health  all  over  the  world.  It  has  enabled  me  to 
approach  some  of  the  greatest  of  living  specialists ;  men  like 
Professor  Ehrlich,  to  whom  all  bow  in  homage ;  Professor  Dr.  S. 
Hata,  of  Tokyo,  his  former  collaborator  ;  Dr.  Simon  Flesner,  of 
New  York ;  the  Director  of  the  Health  Department  in  St.  Peters- 
burg ;  Dr.  Georges  Miron,  of  Bucarest ;  Dr.  L.  J.  Landouzy, 
of  Paris ;  Professor  Gosio,  of  Eome ;  and  many  others  whose 
names  are  too  numerous  to  mention. 

In  London  I  have  received  the  courteous  and  willing  assistance 
of  men  like  Dr.  F.  Mott,  F.E.S.,  Mr.  J.  Ernest  Lane,  Dr.  J.  J. 
Perkins,  Dr.  B.  Burnett  Ham,  late  Director  of  the  Health  Depart- 
ment, Victoria ;  Lt. -Colonel  C.  H.  Melville,  E. A.M. C,  and  several 
others.  And,  lastly,  but  really  first,  I  have  turned  the  pages  of  a 
hundred  or  more  publications  of  varying  importance,  from  the 
invaluable  works  of  Professor  Alfred  Fournier,  Professor  Blaschko, 
Sir  Jonathan  Hutchinson,  and  Dr.  C.  F.  Marshall,  down  through 
medical  journals  of  every  country,  reports  of  proceedings,  blue- 
books  of  all  sorts  and  sizes,  to  newspaper  cuttings  from  a  press- 
cutting  agency. 

These  acknowledgments,  which  I  now  tender  most  gratefully 
to  all  these  gentlemen,  will  at  least  serve  to  show  that,  although 
I  do  not  possess  a  medical  degree,  my  statements  are  based  upon 
the  highest  authorities.  In  a  word,  I  have  dehberately  set  to  work, 
in  the  guise  of  a  journalist,  to  pick  the  brains  of  the  specialists,  to 
put  this  and  that  fact  together  and  to  build  a  composite  whole.  I 
trust  that  the  end  will  be  held  to  justify  the  means,  and  that  I  am 
pardoned. 

The  reader  will  find  that  my  account  of  the  subject  is  placed 
before  him  in  two  different  ways.  If  he  desire  merely  to  become 
acquainted  with  the  broad  facts,  then  I  suggest  that  he  confine 
himself  to  "  the  Letter  "  which  I  have  written  to  my  godson.  If 
full  details  and  figures  are  desired,  then  he  may  turn  to  the 
remainder  of  the  book. 

My  investigation  has  been  concerned  not  only  with  the  causes, 
symptoms  and  effects  of  Sexual  Disease,  but  with  many  side  issues  ; 
the  preventive  measures  adopted  in  various  countries,  the  regulation 
of  prostitution,  clandestine  prostitution,  education  of  young  people 
in  the  elements  of  sex  hygiene,  and  so  on. 

But  the  general  public  is  not  immediately  concerned  with  all 


FOEEWOED  IX 

these  matters,  and  so  it  was  decided  to  publish  immediately  only 
the  articles  which  are  now  presented,  and  at  a  price  which  will 
place  the  book  within  the  reach  of  all.  There  can  be  little  or  no 
margin  of  profit.  Such  as  there  is  will  serve  to  help  forward  still 
more  this  work  of  education. 

"  Education  is  the  transmission  of  life  " — so  it  has  once  most 
strikingly  been  defined.  I  can  give  no  finer  explanation  of  the 
word  as  I  employ  it  in  these  pages. 

We  would  appeal  most  of  all  to  the  great  captains  of  industry 
and  employers  of  labour,  to  the  Governing  Bodies  of  the  great 
educational  establishments  and  the  Headmasters  of  the  Public 
Schools,  to  the  Universities  and  Heads  of  Colleges,  to  the  Directors 
of  the  Polytechnic  establishments,  in  fact  to  all  bodies  having  under 
their  control  the  Young  Man  of  Eighteen  and  upwards.  This 
plague  has  got  to  be  wiped  out  of  existence  and  the  surest  way  to 
achieve  this  end  is  by  warning  men  of  its  perils  ;  especially  at  that 
age,  from  18  to  25,  when  it  is  most  frequently  encountered. 

We  are  confident  that  once  the  grave  dangers  of  the  diseases 
are  appreciated  by  any  of  these  responsible  individuals  no  further 
appeal  will  be  necessary  to  secure  their  whole-hearted  devotion 
to  the  cause. 

My  very  grateful  thanks  are  due  to  Professor  Sir  Thomas 
Oliver  for  giving  up  some  of  his  valuable  time  to  read  through  the 
final  proofs  of  the  book.  His  encouragement,  too,  from  the  pub- 
lication of  the  first  article  in  the  Journal  of  State  Medicme,  has 
been  of  the  greatest  value  in  so  delicate  an  undertaking. 

I  have  also  to  thank  Dr.  A.  W.  Stewart  for  his  kindness  in 
helping  me  with  the  Index ;  and  Mr.  Ernest  Braddock  for  checking 
my  statistical  calculations  in  Chapter  YII. 

Finally,  and  as  a  personal  note,  if  it  is  demanded  why  I,  a  mere 
layman,  should  have  dared  such  a  publication  (no  little  jealousy 
has  already  been  encountered),  my  reply  will  be  found  in  the 
following  pages,  plain  writ  that  all  may  read. 

A.  C.-S. 

The  Middle  Tem2yle, 

London. 
May,  1914. 


CONTENTS. 


PAGES 

I.     THE   PEOBLEM   AND   ITS   SOLUTION  1—9 

II.     THE     SEXUAL     DISEASES— SIMPLE     CHANCRE     AND 

GONOERHOEA       10—22 

Chancre — Antiquity  of  Gonorrhoea — ^Vitality  of  the  Microbe — 
Gonorrhosa  v.  Syphilis— Prevalence  of  Gonorrhoea — Symptoms 
and  Eesultant  Effects — Ophthalmia  and  Blindness — Summary. 

in.    SYPHILIS         23—36 

Historical  Note — Symptoms — The  Tertiary  Period— Resultant 
Effects — Syphilis  and  the  Nervous  System — Syphilis  and 
Other  Diseases — "  A  Lost  Leader." 

IV.     SYPHILIS  [continued)  37—44 

Innocent  Contagion — in  Women — Syphilis  and  Marriage. 

V.     SYPHILIS  [continued)  45—54 

Children  and  the  Hereditary  Factor — Infant  Mortality — in  Great 
Britain — Hereditary  Symptoms  in  Children. 

VL     SYPHILIS  [continued)  55—61 

Innocent  Contagion  of  Nurses  and  Infants — Doctors  and  Midwives 
— Some  Miscellaneous  Cases  of  Innocent  Contagion— Indus- 
trial Employment. 

VII.     THE   PREVALENCE   OF   SYPHILIS 62—82 

Prevalence  in  Various  Localities  throughout  the  World — An 
Estimate  for  England  and  Wales. 

VIII.     SUMMARY   AND   CONCLUSION  83—89 

Salvarsan  Treatment — The  Education  of  the  Individual. 

IX.     A   LETTEE   TO   A   GODSON,  when  he  is  18  years  old     ...  90—104 

A   GLOSSARY   OF   TECHNICAL   TEEMS        105 

INDEX 106,107 


THE   PROBLEM   OF  THE   NATIONS. 

I. 

THE  PEOBLEM  AND  ITS  SOLUTION. 

Ap%a  TToXtTeias  a,Tra(T7]S  vecov  rpocpa. 

"  The  foundation  of  every  State  is  the  education  of  its  youth." — Diogenes. 

"  That  which  is  a  common  concern  to  all  is  very  generally  neglected.  The 
energies  of  man  are  stimulated  by  that  which  depends  on  himself  alone,  and  of 
which  he  only  is  to  reap  the  whole  profit  or  glory.  In  concerns  common  to  him 
with  others  he  employs  with  reluctance  as  much  attention  and  activity  as  his 
own  interest  requires.  He  neglects  that  of  which  he  thinks  other  men  will  take 
care,  and  as  other  men  prove  equally  negligent,  the  common  interest  is  universally 
abandoned." — Aristotle,  Politics,  Book  II,  chap.  ii. 

"  Reforms  directed  towards  the  advancement  of  the  Pablic  Health  must  ever 
take  precedence  of  all  others." — Disraeli. 

"  Till  cant  cease  nothing  else  can  begin." — Carlyle,  The  French  Revolution. 

One  of  the  most  salient  characteristics  of  Thought,  or,  rather, 
of  its  expression  in  speech  and  Hterature,  of  the  present  decade 
will  be  found,  I  think,  in  its  attitude  towards  problems  of  Sex  and 
their  relative  issues.  During  the  past  two  or  three  years  we  have 
gradually  accustomed  ourselves  to  the  frank  discussion  of  subjects 
which,  in  this  country  at  least,  have  been  hitherto  considered 
suitable  for  treatment  only  between  the  covers  of  a  medical  journal, 
or  other  similar  publication  with  a  strictly  limited  circulation. 
To-day,  almost  to  our  consternation,  we  find  ourselves  not  only 
speaking  and  writing  of  topics  of  the  most  intimate  nature,  but 
discussing  them  in  a  manner  and  a  language  unknown  since  the 
period  of  the  Restoration. 

The  merits  of  this  trend  of  thought  in  our  modern  social  life 
may,  in  many  respects,  be  open  to  question,  if  not  actually 
deprecated.  But  in  one  issue,  at  least,  of  the  many  problems  of 
sex  it  has  come  to  be  recognized  by  all  clear-thinking  men  and 
women  that  fearless  and  open  discussion  is  not  only  desirable  but 
absolutely  necessary. 

The  ravages  of  what  is  known  as  "Venereal  Disease,"  or 
"  Sexual  Disease  "  as  I  prefer  to  term  it,  are  at  last  being  brought 
home  to  the  community  in  so  menacing  an  aspect  that  the  British 
1 


2  THE    PKOBLEM   OF    THE    NATIONS 

Press,  as  the  mouthpiece  of  the  "  man  in  the  street,"  has  been 
induced  to  demand,  with  no  uncertain  voice,  of  those  in  authority 
that  "  something  be  done  "  to  check  the  evil. 

At  last,  after  years  of  patient  and  earnest  endeavour  on  the 
part  of  a  handful  of  men  and  women,  a  few  definite  details  and 
statistics  of  this  most  dread  scourge  have  been  published  for  general 
information.  At  last  has  the  Press  under  the  authoritative 
influence  of  The  Times  and  Morniyig  Post  (to  their  honour  be  it 
said)  agreed  to  forgo  the  "  conspiracy  of  silence,"  to  speak  of  the 
facts  as  they  exist,  and,  in  so  doing,  to  employ  terms  which  shall 
admit  of  no  secondary  interpretation. 

Nor  is  it  in  the  daily  press  alone  that  such  articles  have 
appeared,  for,  most  remarkable  of  all  perhaps,  the  English  Beview 
has  recently  published  an  authoritative  paper  upon  "The  Doctors 
and  Venereal  Disease,"  and  followed  it  up  by  other  articles  bearing 
closely  upon  kindred  topics. 

However  greatly  we  may  deplore  the  abnormal  introduction 
of  sex  problems  into  our  present-day  literature,  we  cannot  but 
regard  it  as  a  praiseworthy  policy  when  the  motive  is  concerned 
solely  with  the  exposure  of  certain  facts  which  constitute  the 
gravest  danger  to  the  health  and  well-being  of  thousands  of  our 
fellow-countrymen  and  women,  and  with  the  sincere  desire  to 
stamp  out  the  evil.  And  it  is  only  by  the  widest  propagation  of 
these  facts,  the  nature  of  the  diseases  and  the  remedy  therefor,  that 
the  evil  can  be  checked  and  ultimately  obliterated.  It  is  not  a 
matter  in  which  the  State,  at  least  in  this  country,  can  take  action, 
save  in  a  secondary  degree  only.  "  Speaking  generally,  and  of 
present-day  conditions,  the  ^irevention  and  cure  of  venereal  disease 
among  the  civil  population  of  this  cou7itry  is  a  matter  which  depends 
primarily,  often  wholly,  on  the  action  of  the  itidividual."  ^ 

It  is  a  well-worn  axiom  that  in  this  country  the  State  can  be 
induced  to  help  only  those  who  first  help  themselves.  Practically 
every  movement  of  genuine  importance  must  rely  primarily  upon 
individual  effort.  Such  effort  has  been  evidenced  by  the  agitation 
on  the  subject  during  the  past  eighteen  months,  and  the  State  has, 
upon  its  side,  now  given  evidence  of  its  serious,  if  belated,  con- 
sideration of  the  problem. 

To  take  one  issue  only  of  the  problem,  as  it  has  been  ignored 

'  "  Eeport  to  the  Local  Government  Board  on  Venereal  Diseases."  By 
Dr.  E,  W.  Johnstone.     1913.     Cd.  7029.     Price  2^- 


THE   PEOBLEM   AND   ITS   SOLUTION  3 

by  the  State.  The  number  of  inmates  of  lunatic  asylums  and  of 
other  similar  institutions,  public  and  private,  shows  a  steady 
increase  each  year  that  passes.^ 

.  A  very  large  proportion  of  these  cases  is  due  directly,  or  indirectly, 
to  sexual  disease,  and  they  are  more  or  less  incurable. 

The  V7astage  of  sight,  due  to  ophthalmia  neonatorum  (a  result  of 
gonorrhoeal  infection)  involves  a  loss  of  over  £350,000  per  annum 
to  the  State.^ 

Thus  we  are  spending  hundreds  of  thousands,  probably  millions 
of  pounds  annually  upon  the  erection  and  upkeep  of  institutions 
for  the  admission  and  treatment  of  cases  for  which  there  is  little 
or  no  hope  of  recovery.  Our  institutional  treatment  shows  itself 
more  and  more  inadequate  in  proportion  as  the  number  of  cases 
increases.  We  continue  recklessly  to  spend  these  large  sums  in 
the  vain  endeavour  to  cure  the  results  of  disease.  We  spend — do 
we  spend  anything  at  all,  apart  from  the  Navy  and  Army,  in 
attempting  to  check  and  exterminate  the  disease  itself? 

If  such  a  procedure  is  regarded  as  reasonable,  it  would  appear 
equally  reasonable  to  ignore  vaccination,  allow  small-pox  to  ravage 
the  land,  and  involve  ourselves  in  a  huge  expenditure  attempting 
to  cure  the  vast  number  of  cases  which  would  result. 

Naturally  so  broad  a  comparison  invites  criticism,  but  the  basis 
is  sound.  We  do  not  begin  at  the  wrong  end  in  dealing  with 
small-pox,  why  should  we  do  so  with  sexual  disease,  which 
to-day  is  as  terrible  a  scourge  as  ever  small-pox  was? 

You  will  not  make  a  community  a  good  one  by  Act  of  Parlia- 
ment, nor  will  the  average  man  or  woman  trouble  to  read  through 
Official  Eeports  and  Blue  Books,  nor  the  evidence  given  before  the 
Royal  Commission  now  sitting.  But  the  facts  must  be  made 
known,  and  secure  the  widest  possible  circulation,  before  any  real 
or  lasting  good  effect  can  be  produced.  They  concern  not  only  the 
present  generation,  not  only  those  men  who  through  pure 
selfishness  or  thoughtlessness  acquire  and  spread  the  disease,  but 
thousands  of  innocent  women  and  children,  and  the  generation  yet 
unborn.     It  is  not  merely  a  National  but  an  International  question. 

Nor  have  we  any  guarantee  that  the  outcome  of  the  delibera- 
tions of  this  Royal  Commission  will  differ  from  others  which  will 
have  preceded  it.     With  the  knowledge  of  what  has  happened  upon 

^  I  may  direct  attention  to  the  article  by  Dr.  Ettie  Sayer  upon  "  Mentally 
Defective  Children,"  in  the  Journal  of  State  Medicine,  March,  1914. 


4  THE    PECBLEM    OF    THE    NATIONS 

previous  occasions  he  would  be  a  bold  man  who  asserts  that" the 
Government  proposes  seriously  to  adopt  the  resolutions  which  will 
be  passed. 

But  after  all  there  is  only  one  genuine  measure  of  lasting 
practical  value  which  the  Commission  can  urge  for  adoption.  Let 
them  by  all  means  recommend  increased  hospital  accommodation  ; 
let  the  evidence  for  and  against  "  compulsory  notification"  be  care- 
fully weighed ;  the  extension  of  facilities  for  treatment  be  strongly 
urged  ;  anything  and  everything  which  will  tend  to  alleviate 
suffering  be  advocated.  But  before  everything  else  they  must 
strike  at  the  very  root  of  the  evil. 

The  solution  of  the  problem  lies  in  the  Education  of  the  Individual. 
Nothing  else  will  serve.  Until  adequate  measures  to  this  end  are 
universally  adopted  sexual  disease  will  retain  its  grip  upon  the 
human  race. 

Professional  prostitution,  which  is  quite  erroneously  presumed 
to  form  the  basis  of  the  evil,  is,  as  I  have  shown  elsewhere,  but  a 
comparatively  insignificant  factor  of  propagation.  The  dissemina- 
tion of  the  disease  is  due  in  large  measure  to  what  may  be  termed 
clandestine  or  amateur  prostitution,  to  young  girls  and  women  who 
accept  lovers  either,  it  may  be,  for  the  sake  of  additional  pocket-money 
or  from  mere  sensuality— sexual  impulse,  if  you  will. 

This  factor  will,  from  the  nature  of  things,  never  be  eliminated 
so  long  as  civilization  exists.  The  preaching  of  abstract  morality  is 
a  sheer  waste  of  time  and  energy!  Inculcate  principles  oi  practical 
morality,  the  advantages  of  continence  and  such  like,  by  all  means  ; 
but,  first  of  all,  make  a^n  honest  and  unbiassed  attempt  to  understand 
something  of  human  nature,  something  of  the  strongest  impulse 
which  Nature  has  bestowed  equally  upon  men  and  women.  Then, 
having  done  so,  weigh  the  facts  in  the  balance. 

In  this  complex  modern  civilization  of  ours  the  possibilities  of 
clear  thinking  upon  the  part  of  the  individual  seem  to  become  ever 
more  and  more  remote.  He  is  overwhelmed  with  such  a  mass  of 
detail,  intricate  data  upon  every  conceivable  subject  in  the  world's 
affairs,  that  in  attempting  a  broad  conception  of  the  whole  he  fails 
to  grasp  even  the  significant  facts  of  a  single  part. 

In  nothing  is  this  more  noticeable  than  in  the  subject  of  sexual 
disease,  save  that  there  is  little  or  no  real  attempt  to  visualize 
either  the  whole  or  a  definite  part.  Here  we  have  a  mighty  inter- 
national problem  which  is  so  vast  that  it  practically  escapes  notice. 


THE  PKOBLEM  AND  ITS  SOLUTION  5 

It  is  for  all  the  world  like  that  game  which  one  played  at  school, 
the  game  of  trying  to  find  the  name  of  a  place  on  the  map.  The 
boy  with  a  little  more  imagination  than  the  rest  would  set  the 
name  of  a  country  or  province  which  would  be  printed  in  capitals 
right  across  the  page.     The  ruse  seldom  failed. 

This  system  of  haphazard  thought  has  caused  the  oddest  con- 
fusion in  methods  of  approaching  the  problem.  Of  course  the  vast 
majority  of  people  never  think  about  it  at  all,  unless  they  chance 
to  be  directly  affected.  Then  it  is  regarded  as  a  by  no  means 
unexpected  result  of  a  deliberate  act  which  must  be  concealed  from 
everyone,  the  medical  adviser  included.  But  if  ever  it  is  given  a 
thought  you  will  find  it  muddled  up  with  doctors  and  medicine 
and  scientific  research. 

Now  most  men  and  women  of  education  who  take  any  count  of 
'  things  which  matter '  have  heard  of  the  Ehrlich-Hata  Remedy, 
"  606."  At  least  I  have  been  greatly  surprised  at  the  number  of 
people  having  no  interest  at  all  in  things  medical  who  have  heard 
of  it.  But  if  it  is  to  them  anything  more  than  a  mere  catch-figure 
(to  coin  the  term)  it  will  probably  be  vaguely  dismissed  as  some 
striking  scientific  discovery  which  only  concerns  the  medical  pro- 
fession. That  it  has  any  immediate  connection  with  the  biggest 
problem  of  civilization  never  enters  their  minds. 

For  another  instance  of  this  indiscriminate  kind  of  thought 
take  the  attitude  adopted  by  the  more  advanced  section  of  the 
Women's  Movement,  and  as  it  is  indicated  by  one  of  their  leaders. 
In  a  book  recently  published  this  lady  reiterates  again  and  again  her 
proposals  for  exterminating  sexual  disease.  These  are  :  (a)  Votes 
for  Women  ;  and  (b)  the  absolute  chastity  of  men. 

I  have  been  unable  to  gather  what  line  of  action  is  proposed  in 
the  event  of  the  extension  of  the  suffrage;  but  as  regards  the  second 
proposal  one  can  only  reply  that  the  authoress  has  not  studied  her 
own  sex  sufficiently,  nor  the  real  meaning  of  sexual  impulse.  It  is 
once  again  the  old  futile  attempt  to  make  a  community  good  by  Act 
of  Parliament.  Women  can  and  must  give  invaluable  help  in 
exterminating  the  disease ;  but  they  do  not  need  the  suffrage  to 
assist  them,  nor  will  they  achieve  their  object  by  holding  a  pistol  at 
the  man's  head.  Let  them  set  their  own  house  in  order  first,  check 
the  rapid  spread  of  amateur  prostitution,  so  far  as  it  is  the  fault 
o£  the  women,  by  educating  their  sex  in  an  intelligent  and  rational 
manner.     This  will  not  be  effected  by  hysteria  and  fanaticism. 


b  THE   PROBLEM   OF   THE   NATIONS 

People  will  persist  in  thinking  of  sexual  disease  and  possible 
remedies  just  as  they  think  of  the  measles  or  scarlet  fever  ;  probably 
as  more  trivial  than  these.  If  necessary,  which  would  seem  to  be 
seldom,  it  is  a  matter  for  medical  advice.  They  will  not  realize  that 
sexual  disease  as  a  factor  of  suffering  stands  absolutely  alone.  It 
is  a  thing  quite  apart  from  the  well-known  ailments  and  disorders 
of  life  because  it  has  its  origin,  in  the  majority  of  cases,  in  a 
deliberate  act  of  the  individual :  and  that  act  is  an  integral  part  of 
the  biggest  factor  in  human  affairs,  Sex. 

"  The  merest  platitude  !  "  it  will  be  exclaimed.  Possibly  it  is, 
but  it  is  one  which  has  been  persistently  ignored  in  the  considera- 
tion of  preventive  measures.  Or  if  it  has  not  been  wholly  ignored 
no  more  than  the  vaguest  proposals  on  the  subject  have  been  forth- 
coming. 

By  the  State  regulation  of  prostitution  certain  Governments 
evinced  their  recognition  of  the  driving  impulse  of  sex.  It  was  a 
genuine  attempt  to  localize  and  so  to  check  the  disease.  But  the 
measure  has  failed.  I  do  not  know  of  a  single  country  where  it  can 
be  said  with  truth  to  have  succeeded.  Take  Japan,  for  instance, 
where  prostitution  is  controlled  like  a  Government  department,  and 
where  the  strictest  measures  are  in  force.  In  Professor  Hata's  own 
words  to  me,  "  In  spite  of  all  the  attempts  which  the  Government 
has  made  to  prevent  the  disease,  there  is  little  influence  upon  the 
number  of  cases  of  young  men  and  prostitutes,  or  upon  the 
statistics." 

That  method  has  failed,  or  rather  it  has  not  wholly  succeeded, 
because  it  did  not  strike  deep  enough.  From  whatever  point  of 
view  the  problem  is  regarded,  you  must  ultimately  come  down  to 
the  individual  factor. 

^-'  It  has  been  urged  that  the  elimination  of  sexual  disease  will 
place  a  premium  upon  immorality ;  that  the  knowledge  of  safety, 
or  of  preventive  measures,  will  tend  to  an  increase  of  extra- 
marital intercourse  and  vice.  My  reply  will  be  found  in  the  fol- 
lowing pages.  But  I  may  remark  here  that  those  who  make  the 
assertion  have  very  little  knowledge  of  human  nature.  Fear  of 
contagion  has  never  yet  banished  sexual  impulse.  It  would  not 
destroy  the  impulse  even  if  infection  were  practically  a  certain 
result.  Medical  students  at  the  hospitals  may  be  presumed  to 
know  something  of  the  evil  effects  of  sexual  disease,  but  I  have  yet 
to  learn  that  such  knowledge  has  acted  in  any  degree  as  a  deterrent. 


THE  PROBLEM  AND  ITS  SOLUTION  7 

And  we  must  also  take  into  account  the  effects  of  indulgence  in 
alcoholic  liquor.  This  is  the  invariable  companion  of  sexual  indul- 
gence, when  knowledge  and  the  restraining  influence  of  dread  are 
thrown  to  the  winds. 

One  cannot  give  direct  evidence  in  support  of  such  a  reply,  but 
I  would  state  my  honest  conviction — and  I  make  it  with  the  most 
genuine  sincerity — that  knowledge  of  the  dire  results  of,  and  of  an 
adequate  treatment  for  sexual  disease,  can  only  affect  the  question 
in  an  infinitesimal  degree. 

Get  at  the  individual  himself  by  recognizing  the  intensely  human 
aspect  of  the  subject.  Educate  him  not  merely  in  the  exact  nature  of 
the  disease,  in  the  grave  risks  he  may  run,  in  the  seeking  of  medical 
advice,  and  in  the  unspeakable  suffering  which  he  may  bring  upon 
innocent  people — those  who  are  probably  his  nearest  and  dearest :  but 
educate  him  also  to  realize  that  continence  itself  is  worth  cultivating. 
There  must  be  no  question  of  preaching  morality  and  chastity,  for  every 
sane  person  recognizes  the  futility  of  attempting  to  eliminate  sexual 
passion.  But  show  him  that  he  will  ba  the  finer  man  for  his  continence ; 
that  his  brain  will  be  in  better  working  order,  that  his  body  and  general 
physique  will  be  the  hardier  and  more  strongly  developed.  In  short, 
educate  him  to  realize  that,  by  "self  knowledge,  self  reverence,  self 
control,"  to  his  own  self  he  will  be  the  more  true,  and  to  his  Country  of 
the  more  noble  service. 

And  such  a  measure  is  quite  practicable,  it  is  not  the  dream  of 
.  a  visionary.  It  has  been  adopted  in  our  own  Army  with  the  most 
striking  results.  The  marked  decrease  during  the  past  two  or  three 
years  in  the  prevalence  of  sexual  disease  has  been  due  entirely  to 
improved  methods  of  treatment,  and  to  the  education  of  the 
individual.  And,  as  a  direct  corollary  of  the  latter,  there  is  a 
healthier  and  keener  interest  in  outdoor  games,  there  is  greater 
temperance,  and  there  is  a  finer  sense  of  esprit  de  corps.  As 
Englishmen  we  have  always  been  proud  of  our  Army,  even  though 
it  is  "  such  a  little  one  " ;  but  it  is  no  insular  pride  which  impels 
me  to  assert  that  of  all  the  nations'  armies  our  own  men  now  yield 
pride  of  place  to  none  in  those  qualities  I  have  named. 

Is  there  any  reason  why  the  measure  should  not  be  extended  to 
other  of  our  national  organizations,  to  the  great  centres  of  industry 
and  of  education,  to  the  Government  departments,  to  the  various 
departments  of  local  authorities  and  municipalities,  to  the  banks  ? 
In  particular  the  Boy  Scout  Movement   and   the  Church   Lada' 


8  THE    PROBLEM    OF   THE    NATIONS 

Brigades  would  provide  unique  opportunities  for  getting  at  the 
future  manhood  of  the  country.  All  these  are  thoroughly  organized 
bodies  with  trades  unions,  councils  or  executive  committees.  Turn 
over  the  pages  of  WhitaJcer's  Ahnanack  and  realize  how  many 
employees  there  are  in  the  Civil  Service  alone,  or  even  in  the 
Educational  offices  of  the  London  County  Council.  All  these  are 
especiallj^  easy  of  approach. 

With  a  carefully  devised  organization  the  scheme  is  not  only 
thoroughly  practicable  but  comparatively  easy  of  achievement.  And 
we  go  muddling  along,  in  the  traditional  British  manner,  with  our 
lunacy  statistics  ever  rising ;  our  women-folk  compelled  to  undergo 
serious  operations,  the  need  for  which  should  never  arise  ;  our 
children  incapacitated  from  birth ;  ophthalmia  and  blindness  on  the 
increase ;  our  whole  national  morale  seriously  impaired. 

And  our  remedy  is  to  give  grudging  support  to  institutions 
which  are  hopelessly  inadequate  to  deal  with  the  big  influx  of  cases. 
*  Grudging  '  because  sexual  disease  is  presumed  to  be  the  result 
of  sin. 

Oh,  let  us  have  done  with  this  cant  and  hypocrisy  and  face  the 
problem  like  men  !  "  It  can  be  done,  and  England  should  do  it," 
has  inspired  many  a  fine  thing  in  the  past.  Let  that  motto  of 
Millais's  picture  inspire  to  this,  one  of  the  greatest  and  most  needed 
reforms  of  civilization. 

Of  all  the  great  things  which  England  has  given  to  the  world, 
the  measures  for  the  health  of  the  community  have  been  amongst 
the  greatest  and  noblest.  Let  us  face  this  problem  too  as  English- 
men ever  face  an  enemy,  no  matter  what  the  odds.  Strike  deep  at 
the  heart  of  it,  and  show  the  world  that  we  are  still  a  nation  to  be 
reckoned  with,  that  this  pessimistic  talk  about  race  degeneration  is 
a  myth  bred  of  diseased  minds.  Stamp  out  this  evil  and  in  less 
than  a  decade  of  years  we  shall  be  a  new  nation,  a  nation  more 
worthy  of  the  "  place  in  the  sun  "  which  she  has  won ;  more  worthy 
of  the  children  whom  she  has  sent  overseas  to  uphold  her  honour 
and  keep  the  flag  flying.     It  shall  be  done,  and  England  will  do  it. 

But  if  this  campaign  of  education  is  to  be  embarked  upon  there 
mnst  be  clean  and  frank  discussion.  "  Till  cant  cease,"  said 
Carlyle,  "  nothing  else  can  begin."  This  is  the  difficult  part  of  the 
problem;  but  at  least  the  first  barriers  have  already  been  broken  down. 
Sexual  disease  is  a  horrible  subject,  and  the  fact  cannot  be  disguised. 
It  seems  to  me  that  the  time  is  past  for  vague,  general  hints  as  to 


THE  PKOBLEM  AND  ITS  SOLUTION  9 

its  nature  and  symptoms.  We  have  come  to  such  a  pass  that  the 
pubhc  must  receive  a  clean  knock-out  blow  straight  from  the 
shoulder.  They  must  be  told  exactly  what  sexual  disease  means 
to  the  individual,  to  the  family,  to  the  next  generation,  and  to  the 
nation.  They  must  be  made  to  realize  how  ma,ny  and  how  serious 
are  the  diseases  which  are  the  direct  or  indirect  sequelae  of  syphilis 
and  gonorrhoea.  They  must  be  made  to  realize  the  immense 
importance  of  immediate  and  sound  medical  treatment. 

In  conclusion  I  would  expressly  state  two  facts  to  which  I  shall 
constantly  recur,  and  which  it  is  impossible  to  over-emphasize, 
in  that  they  constitute  the  moral  (if  one  may  so  term  it)  of  the 
whole  subject : — 

(a)  That  sexual  disease  is  less  dangerous  than,  say,  typhoid 
fever  if  adequate  remedies  be  applied  in  the  initial  stages  and  duly 
persisted  in  ;  and  conseque?itly 

(b)  That  the  present  ignorance  and  false  modesty  which  prevail 
on  the  subject  generally  constitute  the  most  powerful  aids  in  the 
widespread  propagation  of  the  disease. 

And  it  is  with  these  considerations  in  mind  that  the  following 
articles  are  written.  "Prefaces,"  Francis  Bacon  once  said,  "are 
great  wastes  of  time,  and  though  they  seem  to  proceed  of  modesty, 
they  are  bravery."  The  "  bravery  "  in  the  present  instance  would 
seem  to  lie  in  attempting  a  task  which  there  are  so  many  better 
qualified  to  perform.  For  the  writer's  qualifications,  such  as  they 
are,  consist  almost  wholly  in  the  fact  that  he  has  for  many  years 
made  a  close  study  of  this  and  kindred  problems  in  many 
European  countries  and  in  the  Far  East ;  that  he  possesses  no 
medical  degree;  and  that  he  attempts,  of  set  purpose,  to  deal 
with  it  from  the  broadly  human  aspect  rather  than  from  the 
scientific. 

"  But  Hercules  himself  must  yield  to  odds ; 
And  many  strokes,  though  with  a  little  axe, 
Hew  down,  and  fell  the  hardest  timbered  oak." 


10 


II. 

THE   SEXUAL  DISEASES. 
Their  Characteristics,  Incidence,  and  Significance. 

The  sexual  diseases  are  three  in  number :  Syphilis,  Gonorrhoea 
and  Simple  Chancre — these  in  order  of  severity. 

Simple  Chancre. 

A  consideration  of  this,  the  least  malignant  of  the  diseases,  need 
occupy  no  more  than  a  few  lines.  Simple  chancre  is  merely  a  local 
affection  which  neither  infects  the  blood  nor  poisons  the  system. 
It  takes  the  form  of  a  contagious  ulcer  or  series  of  suppurative 
sores  which  are  produced  upon  the  contaminated  organ.  Certainly 
there  may  result  complications,  such  as  swelling  in  the  glands  of 
the  groin,  or,  in  very  rare  cases,  a  disease  known  as  phagedena. 
But  chancre  is  readily  accessible  and  comparatively  easily  treated ; 
nor  are  there  any  of  the  serious  after-effects  which  must  claim  our 
attention  when  discussing  the  two  other  forms  of  sexual  disease. 

Gonorrhoea. 

Gonorrhoea  (popularly  known  as  the  "  clap  ")  is  a  specific  disease 
which  may  invade  the  urethral  mucous  membrane  during  sexual 
intercourse,  and  is  caused  by  infection  from  a  pathogenic  microbe 
— the  gonococcus — discovered  by  Neisser  in  1879. 

The  disease  was  well-known  to,  and  prevalent  amongst  ancient 
civilizations,  and  constant  references  to  its  attendant  disorders  are 
to  be  found  in  the  works  of  classical  writers,  from  Hippocrates, 
Aristotle  and  Plato  down  to  the  present  day.^     The  first  description 

'  For  the  historical  aspect  of  Gonorrhcsa  reference  should  be  made  to 
"  Considerations  Historiques  sur  la  Blennorragie,"  Dr.  Eoucayrol,  Paris,  1907. 
For  a  brief  historical  summary,  together  with  some  Notes  upon  the  Legal  Aspect, 
"  A  Text  Booh  on  Gooiorrhcea,"  by  Dr.  Georges  Luys,  translated  into  English  by 
Dr.  Arthur  Foerster,  London,  1913,  is  recommended.  This  work  is  one  of  the 
most  authoritative  and  up-to-date  of  any  upon  the  subject,  and  it  goes  far  to  fill 
that  gap  in  scientific  literature  which  is  referred  to  later. 


GONOEEHCEA  11 

of  gonorrhoea  (so  far  as  I  can  ascertain)  is  to  be  found  in  the  Book 
of  Leviticus  xv.  2  and  3  {circa  1490  B.C.) : — 

"  Speak  unto  the  children  of  Israel,  and  say  unto  them,  when 
any  man  hath  a  running  issue  out  of  his  flesh,  because  of  his  issue 
he  is  unclean. 

"And  this  shall  be  the  uncleanness  in  his  issue:  whether  his 
flesh  run  with  his  issue,  or  his  flesh  be  stopped  from  his  issue,  it  is 
his  uncleanness." 

Incidentally,  it  may  be  noted  that  Moses  fully  appreciated  the 
contagious  nature  of  the  disease,  for  he  gives  specific  directions  as 
to  articles  of  furniture  and  clothing  in  ordinary,  everyday  use.  In 
an  article  of  this  character  it  will  be  unnecessary  to  devote  any 
detailed  attention  to  the  historical  side. 

The  serious  nature  of  gonorrhoea  lies  more  particularly  in  the 
fact  that  unless  adequate  treatment  is  applied  in  the  early  stages, 
and  so  soon  as  possible  after  infection,  it  is  liable  to  become  chronic 
and  so  extremely  difficult  to  cure.  It  may,  for  instance,  remain 
quiescent  in  the  system  for  years,  to  break  out  again,  long  after  the 
patient  has  imagined  himself  to  be  fully  cured,  in  a  variety  of 
complications  of  which  ophthalmia  and  blindness  are  particularly 
frequent  and  serious  examples.^ 

On  the  other  hand,  if  remedies  are  promptly  forthcoming  upon 
the  immediate  appearance  of  the  primary  symptoms,  or,  better  still, 
upon  the  mere  suspicion  that  infection  has  been  acquired,  and  if 
the  treatment  be  continued  in  strict  accordance  with  medical 
advice,  there  is  comparatively  little  danger. 

One  definite  example  may  here  be  given  of  the  retention  by  the 
gonococcus  or  microbe  of  its  vitality  over  a  period  of  years.^  A  man 
has  contracted  gonorrhoea.  Under  medical  advice  he  applies  the 
necessary  remedies,  and  after  a  time,  with  the  disappearance  of 
all  symptoms,  he  discontinues  them  under  the  belief  that  he  is 
cured.  At  the  end  of,  say,  two  years,  he  marries,  and  the  gonococci, 
which  all  this  time  have  remained  dormant  in  the  urethra,  are 
transferred  to  the  virgin  vagina  and  are  there  rejuvenated.  The 
wife  becomes  infected  and  the  husband  becomes  reinfected  with 
his  own  gonococci.     Under  these  circumstances  he  is   practically 

^  Eicord  treated  in  1840  a  patient  whose  illness  dated  from  1800.  Desormeaux 
attended,  in  I860,  an  officer  who  had  not  been  free  from  gonorrhoea,  or  its  sequelse, 
since  181C. 

*  "  SypMloloffy,"  by  Dr.  C.  F.  Marshall,  1906,  p.  415. 


12 


THE   PEOBLEM   OF   THE   NATIONS 


certain  to  attribute  the  blame  to  his  wife,  and  it  needs  no  effort  of 
the  imagination  to  visualize  the  serious  complications  which  may 
thereby  ensue. 

I  have  quoted  this  particular  example  because  it  must  supply 
some  explanation  of  the  extraordinary  number  of  cases  of  infection 
amongst  married  women.  Despite  the  hysterical  assertions  of  the 
more  irresponsible  section  of  the  Women's  Movement,  I  refuse  to 
believe  that  any  man,  save  a  callous  criminal,  will  knowingly  infect 
his  wife  with  such  a  disease. 

For  herein  lies  its  insidious  nature.  A  man  may  adopt  all 
reasonable  precautions,  and  yet  he  may  not  persist  in  them  for  a 
sufficient  length  of  time.  Careless  he  may  be,  but  not  necessarily 
criminal,  for  criminality  implies  the  knowledge  and  the  will.  And 
yet  his  carelessness  may  be  the  cause  of  infinite  suffering. 


GONORRHGEA   V.    SYPHILIS. 

While  the  fact  noted  above,  as  to  the  liability  of  gonorrhoea 
becoming  a  chronic  malady,  is  equally  true  of  syphilis,  the  second 
of  the  sexual  diseases,  yet  it  is  of  the  first  importance  that  the 
fact  be  particularly  emphasized  because  gonorrhoea  is  far  more 
prevalent  than  syphilis. 

In  Japan,  for  instance,  taking  the  youths  of  20  years  of  age 
upon  their  medical  inspection  for  army  service,  the  average  for 
the  years  1909-1912  is  officially  given  as  4"75  per  1,000  suffering 
from  syphilis,  and  15'68  from  gonorrhoea  : — 

Japanese  War  Depabtment. 
Per  1,000  Youths. 


Year 

Syphilis 

Gonorrhoea            Chancroid 

Total 

1909 

5-73 

13-30 

4-45 

23-48 

1910 

4-92 

16-83 

5-35 

27-10 

1911 

4-08 

16-63 

4-54 

25-25 

1912 

4-27 
4-75 

15-93 
15-68 

- 

4-97 
4-83 

-25-19 

Average 

25-26 

Per  100 

Sexual  Disease  Patients. 

Tear 

Syphilis 

Gonorrhcea 

Chancroid 

1909 

24-42 

. . 

56-62 

.. 

18-96 

1910 

18-13 

62-11 

19-75 

1911 

16-17 

. . 

65-83 

17-99 

1912 

16-93 

.. 

63-37 

.. 

19-70 

Average        18-93 


61-98 


19-10 


GONORRHCEA 


13 


The  statistics  (such  as  exist)  of  several  European  countries 
indicate  a  similar  prevalence.  I  append,  as  an  instance,  some 
figures  taken  from  the  20th  supplementary  volume  of  the  Zeit- 
schrift  des  Koniglich  Freussischen  statistischen  Bureaus.  These 
form  a  part  of  the  result  of  an  inquiry  instituted  in  1900  by  the 
Prussian  Board  of  Education  : — 

Berlin  Industrial  Sick  Club. 
Per  10,000  Male  and  Female  Members. 


Year 
1892 
1S93 
1894 
1395 
1S96 
1897 
1898 


The  Three  Sexual  Disbasbs 

Men 
490-9 
550-1 
554-8 
549-0 
655-2 
619-0 
687-5 


Cases  of  Gonorrhcea 


Women 

302-1 

305-2 

92-2 

63-0 

136-6 

171-6 

134-9 

Men 

Women 

309-1 

135-0 

352-5      ■  . 

175-5 

353-2 

47-4 

367-9 

85-1 

443-1 

93-9 

403-5 

99-8 

412-0 

69-0 

It  is  also  of  importance  because  public  attention  is  being  directed 
more  particularly  to  the  ravages  of  syphilis,  to  the  exclusion  of  an 
adequate  consideration  of  the  suffering  caused  by  gonorrhoea.  And 
yet,  if  it  were  possible  to  obtain  direct  evidence  upon  the  subject, 
it  would,  I  think,  be  found  that  in  a  centre  such  as  London  of 
every  ten  individuals  suffering  from  sexual  disease  perhaps  seven 
would  be  infected  with  gonorrhoea.  But  this  is  no  more  than  an 
estimate,  based  upon  personal  general  observation,  for  statistics 
are  not  available  save  in  the  Navy  and  Army,  and  these  certainly 
support  ray  contention. 


Cases  op  Sexual  Disease  in  the  Navy  and  Akmy. 


Navy — 
1911 
1912 

Army — 

Admissions  into  Hospital 

1911 

1912 


Chancroid 

2,349 
2,321 


2,839 
2,684 


Syphilis 

3,617 

3,459 


3,601 
3,421 


Gonorrhoea  and 
its  sequelae 

7,593 
6,887 


7,708 

7,S74 


Army. 


1911 
1912 


Average  Number  "  Constantly  Sick." 

Syphilis  Gonorrhtsa 

415-63         ..         ..         875-98 


350-65 


846-18 


Dr.  J.  Douglas  C.  White,  speaking  at  a  Congress  in  Dublin  in 
1911,  gave  it  as  his  opinion  that  no  fewer  than  500,000  cases  of 


14  THE   PEOBLEM   OF   THE   NATIONS 

sexual  disease  occurred  annually  in  the  United  Kingdom,  say  1  per 
cent,  of  the  total  population,  and  that  of  this  number  gonorrhoea 
accounted  for  at  least  three  times  as  many  as  syphilis. 

Dr.  Johnstone  states^  that  a  large  proportion  of  the  operations 
performed  at  women's  hospitals  are  rendered  necessary  by  gono- 
coccal infection,  that  the  proportion  is,  in  fact,  as  high  as  25  to 
60  per  cent,  of  the  major  operations  performed. 

More  serious  still,  from  the  point  of  view  of  our  racial  develop- 
ment, is  the  estimate  that  about  one-third  of  the  childless  marriages 
are  due  to  gonococcal  infection  in  the  female ;  for  gonorrhoea  is  one 
of  the  most  potent  causes  of  sterility. 

Another  fact  which  is  not  properly  appreciated  is  that  a  subject 
may  become  infected  with  the  disease  merely  through  contact  with 
infected  articles.^  A  child  may,  for  instance,  contract  gonorrhoeal 
ophthalmia  from  the  infected  touch  of  a  parent's  fingers,  or  from 
the  mother  during  parturition.  Comment  upon  such  a  point  is 
wholly  superfluous,  for  it  will  readily  be  seen  how  extensive  is  the 
suffering  which  may  be  inflicted.  And  the  disease  might  so  easily 
be  avoided.     It  depends  upon  the  individual. 

It  is  outside  my  immediate  purpose  to  detail  specific  remedies 
either  for  this  or  other  forms  of  sexual  disease.  I  would  only 
indicate  how  simple  the  course  of  treatment  may  be  if  only  the 
patient  will  disabuse  his  or  her  mind  of  all  cant  and  false  modesty, 
go  direct  to  the  best  available  medical  man  or  institution  immediately 
he  may  suspect  infection,  and  follow  implicitly  and  to  the  last  letter 
the  directions  given.  This  is  only  from  the  "curative"  point  of 
view;  of  the  far  more  important  aspect  of  "prevention"  I  shall 
speak  later  on. 

But  in  a  simple  case  of  gonorrhoea,  with  an  immediate  applica- 
tion of  remedies,  and  the  exercise  of  proper  care  in  general  treat- 
ment of  diet,  &c.,  there  is  no  reason  why  a  patient  should  not  feel 
perfectly  himself  again  within  a  fortnight,  although  this  certainly 
does  not  mean  that  the  remedies  are  to  be  discontinued.  Actual 
discomfort  may  not  indeed  extend  over  a  longer  period  than  a  week. 
But   it   must   emphatically   be   understood   that   each   day   which 

'  L.  G.  B.  "  Eeport  upon  Venereal  Disease." 

^  Dr.  Palmer  Findley  quotes  cases  of  a  woman  infected  from  towels  used 
by  an  inmate  of  the  house,  and  who,  in  turn,  infected  her  husband ;  and  of  several 
members  of  a  family  acquiring  infection  from  the  bathroom.  ("  Gonorrhoea  in 
Women"  p.  21.) 


GONOKRHGEA  15 

passes  without  treatment  will  almost  certainly  involve  the  addition 
of  a  vv^eek  to  such  course  of  treatment  either  inside  or  outside  a 
hospital. 

Prevalence  of  Gonorrhcea. 

For  the  reasons  stated  above  I  have  referred  to  the  prevalence 
of  gonorrhoea  over  syphilis  ;  there  remains  to  give  some  indication 
of  the  extraordinary  prevalence  of  gonorrhoea  itself  as  a  disease. 
In  doing  so  it  is  obviously  most  difficult  to  quote  actual  figures,  and 
one  must  therefore  depend  largely  upon  authoritative  statements 
by  medical  men  and  others  who  are  in  a  position  so  to  speak.  I 
have  little  doubt  that  the  assertions  made  will  be  received  with 
frank  incredulity  by  the  average  individual,  but  they  must  be  faced. 
I  append  some  quotations  direct,  and  without  comment. 

"  The  statement  that,  of  the  adult  male  population  inhabiting 
large  towns,  only  an  insignificant  proportion  escapes  gonorrhoeal 
infection  is  not  at  all  exaggerated." — Neisser. 

"  The  majority  of  all  young  men  acquire  gonorrhoea  before  the 
age  of  30." — Dr.  J.  Douglas  White  and  Colonel  C.  H.  Melville, 
B.A.M.C. 

"It  is  estimated  that  from  40,000  to  50,000  prostitutes  die 
annually  ;  at  least  80  per  cent,  of  this  mortality  is  due  to  the 
direct  effects  of  gonorrhoea." — J.  Taber  Johnson. 

"  In  New  York,  of  1,000  married  men,  800  have  had  gonorrhoea  ; 
90  per  cent,  of  all  these  have  not  been  healed  and  can  infect  their 

wives." — NOEGGERATH. 

"  The  elimination  of  syphilis  and  gonorrhoea  would  reduce  by 
half  the  number  of  diseases  now  treated  by  physicians,  and  a  large 
proportion  of  the  operations  performed  by  surgeons." — Dr.  B. 
Burnett  Ham. 

"  It  has  been  established  beyond  doubt  nowadays  that  about 
70  per  cent,  of  (various  specific  diseases)  met  with  in  married 
women  are  due  to  the  infection  (the  '  gleet ')  of  their  careless, 
ignorant  or  unscrupulous  husbands." — Dr.  Georges  Luys. 

It  is  indeed  difficult  to  write  of  this  widespread  prevalence  of 
gonorrhoea  without  appearing  to  exaggerate.  I  have  never  been 
able  to  understand  why  the  subject  of  this  disease  has  been  so 
neglected  in  favour  of  syphilis,  and  whenever  any  discussion  has 
taken  place  the  impression  has  always  been  conveyed  that,  of  the 
two  diseases,  gonorrhoea  is  far  the  less  serious.     For  example,  in 


16  THE    PROBLEM    OF   THE    NATIONS 

Dr.  Johnstone's  report  the  subject  is  dismissed  in  a  single  page, 
a  fact  which  seems  inexpHcable  when  the  two  concluding  lines  are 
read:  "Probably  there  is  considerably  more  gonorrhoea  in  this 
country  than  syphilis.  Erb  estimated  that  in  Berlin  six  times 
as  many  persons  suffered  from  the  former  as  from  the  latter." 

The  literature  bearing  upon  syphilis  and  its  treatment  is  most 
extensive,  while  gonorrhoea  is,  comparatively  speaking,  ignored. 
And  yet  Dr.  A.  Prince  Morrow  has  stated  that  "  in  the  case  of 
gonorrhceal  infection  the  individual  risks  the  wife  is  made  to  incur 
are  much  more  serious  than  those  following  syphilis.  The  infection 
may  invade  the  cavity  of  the  uterus  and  ascend  to  the  annexial 
organs,  causing  salpingitis,  ovaritis,  peritonitis,  &c.,  destroying  her 
conceptional  capacity  and  rendering  her  irrevocably  sterile,  to  say 
nothing  of  the  resulting  dangers  to  life  and  the  frequent  necessity 
of  surgical  operations  to  remove  her  tubes  and  ovaries." 

Indeed  when  no  more  than  a  cursory  consideration  is  given  to 
the  question  the  figures  and  facts  which  present  themselves  are 
simply  appallmg,  incredible.  It  is  as  though  we  were  asked  to 
believe  that  the  Great  Plague  of  London,  when  one  in  every  four  fell 
dead,  were  actually  now  raging,  but  in  secret  and  behind  closed 
doors.  To  read  an  authoritative  statement  such  as  "  Gonorrhoea 
is  the  most  widespread  and  universal  of  all  diseases  in  the  adult 
male  population,  embracing  75  per  cent,  or  more,"  ^  or  that  of 
Noeggerath  quoted  above,  and  then  to  sit  still  for  a  few  minutes 
with  closed  eyes,  is  to  conjure  up  a  mental  picture  of  misery  and 
suffering  worthy  to  find  a  place  in  "II  Inferno  "  of  Dante. 

One  could  fill  pages  with  such  quotations,  with  heart-breaking 
instances  of  innocent  sufferers;  of  women  deprived,  perhaps  from 
their  very  wedding  night,  of  their  dearest  privilege  in  life  ;  of  ruined 
homes ;  of  babes  doomed  to  a  lingering  death  in  life ;  of — but 
the  brain  refuses  to  frame  the  sentences,  it  is  all  too  hideous.  At 
the  outset  one  may  dispose  oneself  to  write  calmly  and  dispas- 
sionately of  these  things,  to  discuss  them  in  the  cold  light  of 
science  and  reason ;  but  human  feelings  must  assert  themselves 
when  all  else  is  swept  aside  and  forgotten  save  only  the  figure  of 
a  little  child  who  kneels  with  imploring,  upraised  hands  to  the 
gaunt  spectre  of  this  loathsome  disease. 

One  is  indeed  almost  tempted  to  agree  with  Miss  Pankhurst's 

'  Dr.  A.  Prince  Morrow. 


GONORRHCEA  17 

assertion^  that  gonorrhoea  has  not  been  brought  prominently  to 
pubhc  attention  because  the  medical  profession  hesitate  to  publish 
the  appalling  facts.  And  yet  this  would  not  account  for  the 
scarcity  of  purely  medical  literature  (apart  from  short  papers) 
upon  the  subject.  Statistics  in  any  country  are  practically  non- 
existent ;  but  of  this  fact  the  explanation  is  a  simple  one. 

When  a  man  contracts  gonorrhoea  it  is  fairly  certain  that  he 
will  consult,  not  a  properly  qualified  medical  man,  but  a  neighbour- 
ing chemist.  The  chemist,  or  quack,  will  probably  sell  him  (at 
an  exorbitant  price)  a  box  of  capsules,  or  some  drug  possessing 
some  curative  properties,  and  the  man  will  be  temporarily  cured. 
Then  there  may  ensue  one  or  other  of  the  sequela  noted  above. 
In  the  case  of  syphilis  a  man  is  simply  compelled  sooner  or  later 
to  seek  medical  advice,  or  go  into  hospital.  Hence,  in  our  Navy  and 
Army  at  any  rate,  and  in  our  hospitals,  the  case  is  duly  recorded. 

Have  I  said  sufficient  to  show  the  meaning  of  gonorrhoea  to  the 
individual  and  to  the  community?  And  then  I  recall  a  remark 
once  made  to  me  by  a  driver  of  the  Field  Battery  in  which  I  served. 
"Why,  sir,"  he  said,  "a  man  isn't  a  man  until  he  has  had  the 
•  clap.' "  And,  to  our  shame,  that  is  the  attitude  of  thousands  of 
men.  Who  can  wonder  that  women  are  uniting  to  insist  that  such 
things  shall  cease?  And  so  I  force  myself  to  continue,  to  set  down 
facts  still  more  direct,  that  men  shall  realize  (so  far  as  this  may 
serve)  the  misery  and  suffering  of  which  they  may  be  the  agents 
so  long  as  they  adopt  such  an  attitude,  so  long  as  they  consider 
gonorrhoea  a  mark  of  virility,  a  trivial  thing,  a  lesser  evil  than  a 
severe  cold.^ 

"It  is  quite  true,"  as  Fournier'  remarks,  "that  when  properly 
treated  and  free  from  complications,  gonorrhoea  is  only  a  small 
affair ;  that  it  may  be  got  rid  of  with  comparative  ease.  It  is  also 
true  that,  even  when  negligently  treated  (which  is  the  usual  case) 
gonorrhoea  is  most  often  cured  without  actual  complications,  and 
without  future  consequences,  except  the  long  duration,  which  is 

^  "  The  Great  Scourge,'"  by  Christabel  Pankhurst.     1913. 

'  I  would,  however,  here  disclaim  any  intention  of  pointing  to  sexual  disease 
as  the  inevitable  retribution  of  sin.  Such  an  attitude  is  whoUj^  wrong  and  has 
already  worked  incalculable  harm ;  I  shall  deal  with  this  point  in  due  course. 

■■'  The  works  of  Professor  Alfred  Fournier,  late  Physician  to  the  St.  Louis 
Hospital,  Paris,  are  regarded  as  amongst  the  most  masterly  and  authoritative 
of  all  literature  bearing  upon  sexual  disease. 
2 


18  THE   PEOBLEM   OF   THE   NATIONS 

reckoned,  not  by  weeks,  but  by  months  or  even  years.  But  things 
are  not  always  so  simple." 

Speaking  in  a  broad  general  sense  it  is  found  that  there  is 
a  distinct  difference  in  the  pathology  of  the  disease  as  it  affects  the 
sexes.  The  difference  is  one  in  which  the  philosopher  may  suitably 
discover  material  for  thought.  It  lies  in  the  fact  that  in  the 
male  the  incidence  of  gonorrhoea  is  more  visible,  easily  diagnosed, 
but  it  is  also  attended  by  a  far  greater  degree  of  pain  and  dis- 
comfort than  in  the  case  of  the  female.  On  the  other  hand,  in  the 
female,  it  is  very  frequently  non-apparent^ ;  there  is  often  con- 
siderable difficulty  in  distinguishing  possible  symptoms  from  those 
of  other  disorders  ;  there  is  comparatively  little,  if  any,  discomfort ; 
but,  finally,  the  resultant  effects  are  often  of  the  most  serious 
character,  involving,  as  remarked  above,  sterility  and  acute 
abdominal  diseases. 

Having  regard,  then,  to  this  tolerant  attitude  adopted  by  so 
many  men  towards  gonorrhoea  it  only  remains  that  the  facts  must 
be  driven  home  into  the  public  mind  still  more  emphatically. 
And  in  attempting  the  task,  I  cannot  do  better  than  follow  the 
scheme  adopted  by  Fournier.^ 

In  the  first  place,  in  the  case  of  the  male,  the  initial  treatment, 
from  the  fault  of  either  patient  or  doctor,  may  not  prove  efficacious, 
and  the  gonorrhoeal  discharge  from  the  urethra  may  persist  for 
some  considerable  time.  This  obviously  tends  to  a  possible  spread 
of  infection  ;  for  instance  through  the  media  indicated  in  the  note 
to  p.  14  {suijra). 

Secondly,  the  discharge  may  fail  to  dry  up  completely  and  so 
may  generate  a  chronic  disorder  and  discharge  called  gleet.  This 
is  certainly  one  of  the  most  obstinate  of  all  disorders  and  one  of 
the  most  difficult  to  cure.  It  involves  a  prolonged  and  painful 
treatment ;  it  is  liable  to  frequent  recurrences,  and  may  indeed 
after  all  prove  refractory  to  every  kind  of  treatment. 

Under  a  third  heading  may  be  classed  two  of  the  most  common 
complications  attending  gonorrhoea  :  (a)  Epididymitis,  consisting 
of  an  acute,  painful  inflammation  of  the  epididymis,  a  small  organ 

'  Incidentally  it  should  be  noted  that  this  frequent  ignorance  on  the  part  of 
the  female  that  she  has  actually  contracted  gonorrhoea  forms  another  significant 
factor  in  its  propagation. 

-  "  TJie  Prophylaxis  of  Syphilis,'"  by  Alfred  Fournier;  English  translation  by 
Dr.  C.  F.  Marshall,  1906,  pp.  197  et  seq. 


GONORRHCEA  19 

attached  to  the  testicle  ;  and  (b)  GonorrhcBal  Bheumatism,  which 
is  constituted  by  symptoms  resembling  ordinary  rheumatism. 

In  addition  to  these  gonorrhoea  may,  in  more  exceptional  cases, 
react  upon  a  number  of  other  organs.  To  quote  verbatim  from 
Fournier :  "  It  may,  for  instance,  react  on  the  bladder,  on  the 
prostate,  in  the  form  of  congestion,  inflammation  and  abscess 
which  requires  to  be  opened  immediately  to  avoid  worse  dangers  ; 
on  the  kidneys  ;  on  the  eye,  by  inoculation  carried  there  by  the 
fingers  soiled  with  pus,  or  in  some  other  manner,  an  inoculation 
which  causes  an  acute  ophthalmia  which  may  destroy  the  eye  in  a 
few  days  ;  on  the  heart ;  even  on  the  spinal  cord,  causing  paralysis 
of  the  lower  limbs  and  the  bladder;  even  on  the  brain." 

"What!  Are  you  answered?"  one  may  exclaim  with  Shylock. 
Is  gonorrhoea  still  that  trivial  disease,  to  be  treated  of  no  account  ? 

Here,  then,  we  have  a  definite  statement,  from  one  of  the 
greatest  authorities,  which  it  is  impossible  to  contravert,  for  the 
actual  cases  are  duly  recorded ;  functional  disorders  of  the  gravest 
character  from  which  death  itself  must  often  come  as  a  merciful 
release — for  death  has  been  known  in  many  cases  to  supervene. 
"To  cite  one  order  of  cases  only,"  says  Fournier,  "out  of  eleven 
cases  of  acute  inflammation  of  the  spinal  cord  caused  by  gonorrhoea 
eight  have  been  known  to  terminate  fatally." 

I  have  referred  to  the  liability  of  gonorrhoea  developing  into  a 
chronic  complaint,  and  have  given  instances  of  ophthalmia  and 
blindness,  and  of  the  sterility  and  serious  disorders  which  may  be 
inflicted  upon  innocent  women  through  the,  often,  reckless  careless- 
ness of  an  infected  husband.  Perhaps  most  sad  and  cruel  of  all, 
I  have  spoken  of  the  helpless  babe  contracting  at  birth  some  form 
of  the  disease.  Surely  no  more  potent  argument  than  this  last  is 
needed  to  secure  a  full  consideration  of  all  the  facts,  and  the 
determination  on  the  part  of  the  individual  and  the  community  to 
stamp  out  gonorrhoea  from  civilization. 

Is  it  realized  what  sterility  (especially  when  it  is  apparently 
inexplicable)  means,  to  the  individual,  apart  from  the  community '? 
To  the  husband  or  wife  who  reads  these  lines  it  may  mean  nothing 
save  an  order  of  things  definitely  pre-arranged,  a  deliberate 
intention  to  refrain  from  procreation.  With  such  a  one  I  am 
not  immediately  concerned.  But  what  of  the  young  wife  to  whom 
the  gift  of  a  child  would  prove  the  dearest  pledge  of  her  love  for 
her  husband  ?  Ignorant  of  the  cause,  she  undergoes  the  humiliation 


"20  THE    PROBLEM    OF   THE    NATIONS 

of  childlessness.  In  vain  she  sets  afloat  over  the  Serpentine  her 
little  prayer  to  old  Solomon  Caw.  In  vain  she  listens  for  the  tiny 
voice  of  her  dream-child  crying  to  come  to  her ;  the  patter  of  "  little 
feet  along  the  floor."  And  so  may  come  gradual  estrangement 
between  husband  and  wife ;  the  break  between  two  hearts  which, 
a  few  short  years  before,  had  seemed  to  join  in  a  lifelong  union; 
and  at  last  the  dissolution  of  a  home  which  had  never  been 
a  home.  And  all  because,  perhaps,  of  one  single,  seemingly  trivial 
incident  in  the  husband's  life  of  years  ago — a  birthday  dinner, 
a  visit  to  a  music-hall,  a  little  half-hour  in  a  woman's  company. 
And  the  blame  attaches  to  the  wife,  not  to  the  husband  ! 
"  What !     Are  you  answered  yet  ?  " 

Ophthalmia  and  Blindness. 

Here,  then,  are  a  few  facts  and  figures  concerning  the  prevalence 
oi  a  form  of  'pi-eventible  blindness — Ophthalmia  Neonatorum^ — 
which,  as  already  remarked,  is  a  result  of  gonorrhoeal  infection. 
These  details  are  taken  from  a  report  issued  in  1909  by  the 
British  Medical  Association.  I  will  set  them  down,  again  without 
comment  : — 

(1)  Ophthalmia  neonatorum  is  by  far  the  most  common  cause 
of  blindness  in  children. 

(2)  It  was  estimated  that,  in  1899,  about  7,000  persons  in  the 
United  Kingdom  had  lost  their  sight  from  ophthalmia  neonatorum. 

(3)  In  the  United  States  it  was  estimated  that,  of  the  total 
cases  of  blindness  under  one  year,  over  25  per  cent,  were  due  to 
ophthalmia  neonatorum. 

(4)  In  London  it  was  calculated  that  of  all  children  born  1  per 
cent,  suffer  from  ophthalmia  during  the  first  few  days  of  life,  and, 
of  these,  one  in  twenty  is  blinded  or  partially  blinded  as  a  result  of 
the  disease. 

(5)  In  Lancashire  the  figure  stands  at  2  per  cent. ;  cf.  (4),  supra. 

(6)  In  the  various  blind  asylums  and  schools  the  percentage  of 
cases  due  to  ophthalmia  neonatorum  varies  from  27  to  75  per  cent., 
the  average  being  about  35  per  cent. 

From  these  and  other  data  the  conclusion  that  ophthalmia 
neonatorum  accounts  for  upwards  of  10  per  cent,  of  all  cases  of 
blindness  can  hardly  be  termed  an  exaggeration. 

'  By   Local   Government   Board   Order    of    February    5,    1914,    Ophthalmia 
Neonatorum  has  been  rendered  compulsorily  notifiable  in  England  and  Wales. 


GONOERHCEA  21 

And  yet  it  is  seriously  asserted  that  sexual  disease,  and  its 
sequelae,  is  the  "retribution  of  sin."  May  I  invite  the  attention  of 
those  who  labour  under  that  delusion  to  the  above  details?  If 
gonorrhoea  is  stamped  out  of  existence  ophthalmia  neonatorum  will 
also  cease  to  exist. 

As  a  corollary  I  may  add  another  fact,  which  will  appeal,  I  have 
no  doubt,  to  the  London  taxpayer. 

It  is  estimated  that  36  per  cent,  of  the  blind  children  in  the 
London  County  Council  schools  have  lost  their  sight  from  this 
form  of  ophthalmia.  It  is  also  estimated  that  the  cost  of  the  educa- 
tion of  a  blind  child  varies  from  £350  to  ^6500,  compared  with  about 
£60  in  the  case  of  a  child  with  normal  vision.  If  we  take  the 
figure  of  cost  as  £400,  and  if  we  imagine  for  the  moment  that 
ophthalmia  neonatorum  had  not  existed,  the  London  taxpayer  would 
have  saved  £12,600  over  that  one  deal.  I  mentioned,  in  the  in- 
troductory chapter,  that  the  State  is  involved  in  a  loss  of  over 
£350,000  per  annum  owing  to  this  preventible  wastage  of  sight.  ^ 

Two  more  specific  divisions  in  possible  resultant  effects  from 
gonorrhoea  and  I  conclude  this  chapter. 

The  most  common  and  also  the  most  serious  of  all  such 
results  is  found  in  stricture  of  the  urethra.  "  Sometimes,"  says 
Fournier,  "  it  is  amenable  to  mild  forms  of  treatment,  but  it  is 
often  only  cured  by  surgical  intervention.  Further,  a  neglected 
stricture  may  become  the  point  of  origin  of  grave  complications^ 
affecting  the  prostate,  bladder  and  kidney.  Then  everything  is 
possible,  even  death,  which  is  not  rare  in  such  cases." 

And,  lastly,  there  are  frequently  to  be  found  definite  and 
permanent  affectio7is  of  the  joints  resulting  from  gonorrhoeal 
rheumatism.  Here  again  there  may  be  no  more  than  a  per- 
manent stiffness,  say  of  the  fingers  ;  but  many  cases  are  upon 
record  of  a  total  disablement  of  various  limbs. ^ 

Summary. 

For  reasons  already  indicated  I  have  dwelt  in  considerable 
detail  upon  this  subdivision  of  sexual  diseases ;  and  yet  I  cannot 
but  feel  that     "  the  half  is  not  yet  told."     But  at  least  we  have 

^  If  further  evidence  upon  this  subject  is  desired,  those  interested  may  obtain 
it  from  "  Report  to  the  Local  Government  Board  for  Scotland  upon  the  Incidence ' 
of  Ophthalmia  Neonatorum  in  Scotland,"  by  Dr.  T.  F.  Dewar.     1912.     Price  4d. 

-  In  the  woi-k  above  referred  to  Fournier  quotes  several  specific  cases. 


22  THE   PEOBLEM   OF   THE   NATIONS 

sufficient  data  from  which  to  draw  some  definite  conclusions  and 
a  summary  : — 

(1)  That  gonorrhoea,  though  comparatively  ignored  as  a  disease 
by  the  medical  profession  and  by  the  public  generally,  is  in  reality 
one  of  the  most  prevalent  of  all  diseases,  if  not  actually  the 
dominant  disease  of  the  human  race. 

(2)  That  in  comparison  with  the  incidence  of  syphilis,  gonor- 
rhoea is  probably  three  times  as  prevalent. 

(3)  That  it  forms  one  of  the  most  potent  causes  of  sterility  in 
women,  and  is  accountable  for  a  large  proportion  of  the  major 
surgical  operations  performed  on  women. 

(4)  That  gonorrhoea  forms  the  direct  cause  of  ophthalmia 
neonatorum,  and  so  of  more  than  10  per  cent,  of  all  cases  of  blind- 
ness ;  of  more  than  one-third  of  the  blindness  affecting  inmates 
of  schools  and  asylums  below  the  ages  of  16  or  18  years. 

(5)  That  if  submitted  to  adequate  treatment  in  its  initial  stages 
gonorrhoea  constitutes  only  a  mild  affection,  at  least  in  the  majority 
■of  cases. 

(6)  That  through  inadequacy  of  treatment,  or  similar  causa- 
tions, it  has  a  strong  tendency  to  become  chronic,  involving  various 
more  or  less  serious  complications. 

(7)  That  in  some  cases,  happily  comparatively  rare,  the  disease 
itself,  or  its  remains,  becomes  the  most  serious  affection  and  one 
capable  of  the  gravest  terminations,  even  of  death. 

The  solution  of  the  problem  lies  in  the  Education  of  the 
Individual. 


23 


III. 
SYPHILIS. 

[there  is]  "  sheer  moral  cowardice  in  shirking  from  a  large  and  serious  inquir 
into  the  extent,  the  causes,  the  palliating  of  this  hideous  scourge." — Loed  Morlei 
at  the  Banquet  to  the  International  Medical  Congress,  1913. 

Historical  Note. 

"  The  origin  of  syphilis  in  Europe,"  it  has  been  said,  *'  is  one  c 
the  classical  battle-fields  of  medical  history."  The  point  at  issue  i 
whether  the  disease  has  been  known  to  our  civilization  sine 
remotest  antiquity,  or  whether  it  was  introduced  into  Europe  b 
the  sailors  of  Christopher  Columbus,  who  are  said  to  have  contracte 
it  in  Haiti  and  Central  America. 

The  matter  has,  however,  little  bearing  upon  our  present  purpos 
and  it  may  be  remarked  in  summary  of  the  discussion  that  th 
evidence  of  all  contemporary  writers  tends  to  show  that  syphili 
was  unknown  in  Europe  before  the  year  1493,  and  that  it  wa 
actually  introduced  from  America.  Our  English  literature  of  th 
Tudor  and  Stuart  periods  abounds  in  references  to  the  disease,  c 
'pox'  and  anyone  interested  may  find  at  least  twenty  or  thirt 
such  references  in  the  plays  of  Shakespeare.-^ 

In  short,  syphilis  was  most  prevalent  in  Europe  at  that  perio 
of  history,  and  the  most  direct  cause  of  its  propagation  was  to  t 
found  in  the  wars  continuously  waged  between  European  State 
and  the  formation  of  large  bands  of  mercenaries  which  wei 
invariably  accompanied  by  considerable  numbers  of  camp-followin 
women.  In  Scotland  it  is  first  heard  of  in  1497,  when  James  I 
published  a  decree  that  all  syphilis-infected  cases  should  lea\ 
Edinburgh  for  treatment  near  Leith. 

•  I  am  indebted  to  Dr.  David  Newman,  of  Glasgow,  for  drawing  my  attentic 
to  the  fact  that  syphilis  formed  the  subject  of  Cardinal  Wolsey's  indictme] 
before  the  House  of  Lords  in  1529 :  "  Whereas  your  Grace  is  our  Soverei^ 
Lord  and  Head,  in  tvhom  standeth  all  surety  and  tuealth  of  this  realm,  t) 
same  Lord  Cardinal,  knowing  himself  to  have  the  foul  and  contagious  disea 
of  the  great  pox,  broken  otit  upon  him  in  divers  places  of  his  body,  came  dai 
to  your  Grace,  roivning  in  your  ear,  and  bloioing  upon  your  most  noble  Gra 
with  his  perilous  and  infected  breath,  in  marvellous  danger  of  your  Highness: 


24  THE   PEOBLEM   OP   THE   NATIONS 


What  is  Syphilis? 


To  give  a  purely  technical  definition,  "  Syphilis  is  a  contagious- 
disease,  chronic  in  evolution,  intermittent  in  manifestations,  and 
indefinite  in  duration,  caused  by  a  specific  microbe  discovered  by 
Schaudinn  in  1905."^ 

Or  to  describe  it  in  more  simple  language,  syphilis  is  a  disease 
caused  by  a  certain  definite  poison  w^hich  is  introduced  into  the 
system  only  by  actual  contact  with  the  poisoned  or  infected  part  of 
another's  body,  or  an  article.  When  once  infected,  and  unless 
adequate  remedies  and  treatment  are  forthcoming,  the  poison  may 
in  time  permeate  to  any  part  of  the  body,  from  the  glands  nearest 
to  the  infected  spot  to  the  nervous  system  itself.^ 

Speaking  generally  a  person  may  become  infected  in  one  of  two- 
ways  :  by  (a)  sexual  contact,  i.e.,  through  sexual  intercourse  with  an 
infected  person,  and  (6)  non-sexual  contact,  i.e.,  from  some  infected 
person,  or  from  an  article,  such  as  a  barber's  razor,  a  vaccination 
lancet,  &c.,  or  from  kissing,  from  drinking  out  of  an  infected  cup,, 
&c.  Under  this  heading  I  include  all  cases  of  '  innocent '  conta- 
gion. These  two  methods  of  contagion  will  be  more  carefully  con- 
sidered and  differentiated  later. 

While  sexual  infection  is  by  far  the  more  common,  yet  it  is  a 
grave  mistake  not  to  take  serious  account  of  the  large  number  of 
cases  due  to  non-sexual  contact.  A  mistake  because  of  the  attitude 
of  stern  morality  which  people  are  wont  to  adopt  towards  the 
unfortunate  sufferer  ;  the  conviction  that  the  disease  must  neces- 
sarily be  due  to — a  "  moral  lapse,"  shall  we  say?  I  shall  give  some 
specific  instances  of  such  causes  of  infection. 

The  poison  of  syphilis  may  first  attack  practically  any  part  of 
the  body.  It  is  by  no  means  confined,  as  is  popularly  supposed,  to 
the  genital  organs,  although  that  is  naturally  the  region  where  the 
disease,  when  due  to  sexual  contact,  more  commonly  first  manifests 
itself. 

Syphilis  is  a  clironic  disease.  That  is  to  say,  when  once  the 
poison  has  invaded  the  system,  the  body  remains  in  a  state  of 
infection,  either  latent  or  open,  for  an  absolutely  indefinite  period. 
The  disease  may  show  signs  of  its  presence  five  or  ten  years  after 

1  "  SypJiilology,"  by  Dr.  C.  F.  Marshall,  London,  1906. 

'  "  The  whole  body  is  its  domain,"  says  Fournier,  "from  head  to  foot.     It  is 
hence  par  excellence  a  general  disease." 


SYPHILIS 


25 


the  original  infection.  Cases  are  recorded  of  symptoms  appearing 
from  twenty-live  to  fifty-five  years  after. 

But  these  symptoms  are  intermittent  in  their  appearances. 
Though  the  body  may  remain  infected  there  may  quite  possibly  be 
no  open  and  visible  sign  of  the  disease,  save  at  intervals.  The 
patient  may,  in  fact,  imagine  himself  to  be  fully  cured.  Then 
another  outbreak,  more  serious  than  the  last,  may  appear  in  a 
totally  different  part  of  the  body.  Fournier  compares  a  body  in 
such  a  condition  to  a  volcano  in  a  state  of  intermittent  eruption ; 
a  series  of  distinct  outbreaks  separated  from  each  other  by  periods 
of  quiescence. 

Following,  then,  the  technical  definition,  such  is  the  general 
character  of  syphilis,  one  of  the  most  terrible  diseases  known  to 
civihzation  ;  the  "  modern  plague,"  as  it  has  been  termed. 

And  yet  this  disease  is  less  dangerous  than  typhoid  fever,  pro- 
vided that  treatment  is  promptly  applied  and  rigidly  adhered  to. 
It  depends  upon  the  individual. 

Symptoms. 

The  symptoms  of  syphilis  are  classified  under  three  distinct 
heads,  as  they  appear  in  chronological  order.^  Thus  the  first 
appearance  of  the  disease  after  contagion,  usually  in  about  thirty 
days,  and  evidenced  by  no  more  than  a  comparatively  insignificant 
sore  called  the  chancre,  is  spoken  of  as  the  primary  sij7nptom. 

This  primary  period  usually  lasts  about  six  weeks,  and  the 
chancre,  which  appears  at  the  spot  where  contagion  was  effected, 
will  probably  heal  up  quite  rapidly.  And  herein  lies  the  danger. 
The  chancre  is  in  many  cases  so  insignificant  in  size  or  appearance 
that  it  may  readily  be  mistaken  for  a  pimple,  a  small  abrasion  ;  or, 
indeed,  it  may  not  even  be  noticed.^  Attention  is  generally  directed 
to  the  chancre  by  a  certain  itching,  or  feeling  of  irritation.  This  is 
an  ordinary,  normal  case,  but  it  must  be  remembered  that  in  all 
stages  of  the  disease,  even  from  the  primary  period,  the  severity  of 
the  attack  and  exact  nature  of  the  symptoms  vary  with  the  individual. 

Imagine  then  that  the  primary  period  has  run  its  course  ;  that 
the  symptoms  have  been  made  light  of,  or  that  the  application  of 

>  Strictly  speaking  the  clinical  course  of  syphilis  is  divided  into  six  stages. 
Eor  a  clear  and  detailed  account  of  these  reference  may  be  made  to  "  Syphilis;' 
by  Colonel  F.  J.  Lambkin,  R.A.M.C.     London,  1910. 

-  "  The  Treatment  of  Syphilis;'  Alfred  Fournier. 


26  THE   PROBLEM   OF   THE   NATIONS 

remedies  has  ceased  with  their  speedy  disappearance.  The  secondary 
period  is  then  entered. 

The  poison  has  by  now  more  or  less  thoroughly  permeated  the 
entire  body,  and  it  begins  to  indicate  its  presence  by  eruptions 
on  the  skin  and  mucous  membranes.  Generally  the  secondarij 
symptoms  begin  with  a  rash  upon  the  trunk,  or  perhaps  with  head- 
aches and  insomnia,  and,  in  women  particularly,  with  ansemia. 
There  may  follow  such  disorders  as  ophthalmia,  pains  in  various 
joints  and  muscles,  affections  of  the  nerves. 

In  all  this  there  is  nothing  really  serious  ;  nothing,  that  is,  which 
may  not  be  cured  comparatively  easily.  The  particular  danger  of 
the  secondary  period  lies  in  the  fact  that  it  is  the  period  when  the 
disease  is  most  contagious,  when  it  becomes  most  dangerous  to 
others.  There  is,  naturally,  acute  discomfort,  even  pain,  and 
certainly  disfigurement.  These  symptoms  should  subside  under 
proper  treatment.  "  By  itself  it  is  a  trifle ;  but  by  its  contagious- 
ness it  is  a  plague." 

The  Tertiaey  Period. 

If  then  the  subject  has,  at  this  stage,  consented  to  undergo  pro- 
longed and  careful  treatment,  and  if  such  treatment  has  proved 
successful,  then  one  may  reasonably  expect  to  find  the  disease  at  an 
end.  But  if  the  subject  has  been  insufficiently  treated  then  the 
tertiary  symptoms  are  inevitable.  In  fact  the  chief  cause  of  the 
development  of  tertiary  symptoms  is  almost  invariably  inadequate 
treatment.^  At  the  same  time,  however,  it  should  be  observed  that 
there  is  no  sharp  dividing  line  between  seco7idary  and  tertiary 
symptoms.  Cases  of  secondary  or  contagious  lesions  have  been 
observed  so  long  as  fifteen  years  after  the  original  infection  ;  and 
instances  of  tertiary  lesions  have  been  recorded  during  the  second 
year  of  the  disease. 

But  assuming,  once  again,  inadequate  treatment  we  now  come 
to  the  real  disease  in  all  its  gravity.  It  is  the  tertiary  period 
which  makes  syphilis  the  hideous  plague  it  is.  In  a  work  of  this 
nature,  destined  for  wide  general  circulation,  one  naturally  hesitates 

^  Fournier  gives  statistics  showing  that,  out  of  100  cases  of  tertiary  syphilis, 
78  were  due  to  inadequate  treatment,  19  had  received  average  treatment,  and  3 
only  had  been  properly  treated.  Major  W.  S.  Harrison,  R.A.M.C.,  states  that 
since  treatment  in  the  British  Army  has  been  properly'  systematized  cases  of 
malignant  syphilis  are  almost  unknown. 


SYPHILIS  27 

to  write  of  these  facts  in  detail,  to  state  definitely  what  these 
symptoms  are.  And  yet  if  this  is  not  done  how  else  may  one  bring 
home  to  the  public  the  meaning  of  syphilis  ?  Perhaps  it  will  be  best 
to  give  here,  with  but  little  comment,  a  table  prepared  by  Fournier 
to  show,  in  relative  proportion,  the  various  organs  of  the  body 
attacked  by  the  disease  in  its  tertiary  period.  Observations  had 
been  carried  out  upon  an  aggregate  number  of  4,700  patients  : — 

Cases 

Affections  of  the  skin           . .         .  •  . .  •  •         •  •         •  •  1,518 

Subcutaneous  tumours         . .          . .  . .  • .          •  •          •  •  220 

Tertiary  lesions  of  the  genital  organs 540 

,,  tongue        ..  ..          .-          ••          ••  277 

,,  palate         ..  ..         ••          ••          ••  218 

,,  throat         ..         .. 118 

,,  lips             45 

,,  tonsils        ..  ..         ••          ••         ••  12 

, ,  nasal  mucous  membrane  . .         .  •  10 

,,  bones          . .  . .          •  •          •  •          •  •  556 

,,  joints          . .  . .          •  •          ■  ■          •  •  22 

, ,  muscles      . .  . .          ■  •         •  •          •  •  ".S 

,,  digestive  tube  ..          .-         ..         ■•  22 

,,  larynx        ..  ..          ..         ••         ••  ^^ 

,,  lung            ..  ..          ••          ••         ••  23 

, ,  heart           . .  . .          •  •         •  •         • •  ^2 

, ,  aorta           . .  .  •          • •          •  •         •  •  ^^ 

, ,  liver            - .  • .         •  •          •  •         ■  •  ^1 

, ,  kidney        . .  . .         •  .          •  •         •  ■  ^9 

,,       eye  . .         .  •         •  •         •  •         •  •         111 

99. 

, ,       ear  . .  . .  •  •         •  •  •  •  ■^^ 

, ,  . ,  , ,       arteries  and  veins  . .  . .  •  •  17 

Syphilis  of  the  brain,  spinal  cord  and  nervous  system  generally     2,009 
Other  lesions  . .         . .         . .  . .         .  •  •  •  •  •         •  •  "^ 

Two  points,  arising  out  of  the  above  table,  suitably  call  for 
comment.  The  first  thing  which  must  at  once  strike  the  reader  is 
the  astonishing  uhiquitij  of  the  disease  ;  that  no  single  organ  of  the 
body  is  immune  from  attack.  I  have  referred  to  the  fact  that  the 
severity  and  exact  nature  of  that  attack  vary  with  the  individual 
subject.  Thus,  taking  three  cases  of  tertiary  symptoms,  the  first 
subject  may  develop  epilepsy,  the  second  some  form  of  lung  disease, 
and  the  third  may  become  totally  blind. 

Syphilis  and  the  Nervous  System. 

The  second  point  which  will  be  noticed  is  the  enormous  number 
of  cases  in  which  the  nervous  system  is  affected:  2,009  in  4,700 
patients!  Does  this  fact  throw  any  additional  light  upon  my 
introductory  remarks  on  the  subject  of  insanity?  The  very 
centre  and  directing  agent  of  the  human  body  forms  the 
CHIEF  POINT  OF  ATTACK  BY  TERTIARY  SYPHILIS.     And  the  converse 


28  THE  PROBLEM  OF  THE  NATIONS 

of  this  is  equally  true :  that  syphilis  is  by  far  the  most  important 
cause  of  disease  of  the  nervous  system. 

The  close  inter-relationship  between  syphilis  and  the  degenera- 
tion of  the  nervous  system  would  provide  material  for  a  bulky 
volume.  Especially  is  this  so  at  the  present  time  when,  owing  to 
the  conditions  under  which  most  of  us  live,  the  nervous  system 
offers  less  and  less  resistance  to  the  strain  placed  upon  it.  Statistics 
for  Great  Britain  are  not  available,^  but  the  evidence  given  by 
specialists  all  tends  to  confirm  the  experience  of  Founiier.^ 

Erb,  for  instance,  speaking  of  locomotor  ataxia,  or  tabes, 
records  that  out  of  300  cases  in  private  practice,  89  per  cent, 
had  had  syphilis. 

Moebius  has  said,  "  The  longer  I  reflect  upon  it  the  more 
firmly  I  believe  that  tabes  never  originates  without  syphilis.'' 
And,  according  to  Sir  William  Osier,  writing  in  1912,  recent 
results  of  cases  tested  with  the  Wassermann  reaction  bear  out  this 
statement. 

As  regards  general  paralysis,  I  venture  to  quote  verbatim 
an  entire  paragraph  from  a  work^  of  Sir  "William  Osier's  : — 

"As  in  tabes,  the  important  factor  is  syphilis,  which  is  ante- 
cedent in  both  conditions  in  practically  all  cases.  Males  are 
affected  much  more  frequently  than  females.  It  occurs  chiefly 
between  the  ages  of  thirty  and  fifty-five,  although  it  may  begin  in 
childhood  as  the  result  of  congenital  syphilis.*  An  overwhelming 
majority  of  the  cases  are  in  married  people,  and  not  infrequently 
both  husband  and  wife  are  affected.  Statistics  show  that  it  is 
more  common  in  the  lower  classes  of  society,  but  in  America, 
in  general  medical  practice,  the  disease  is  certainly  more  common 
in  the  well-to-do  classes.  Heredity  is  a  more  important  factor 
here  than  in  tabes,  although  its  influence  is  not  great.  .  .  .  The 
habits  of  life  so  frequently  seen  in  active  business  men  in  our 
large  cities,  and  well  expressed  by  the  phrase  '  burning  the  candle 
at  both  ends,'  strongly  predispose  to  the  disease." 

^  Of  Continental  statistics  Hjelmann  gives  15-25  cases  of  nervous  disease  per 
1,000  syphilitics,  excluding  general  paralysis  and  tabes  ;  Reumont  85  per  cent.,  and 
Engelstedt  5  per  cent. 

-  For  specific  cases  and  other  valuable  data  reference  should  be  made  to  Dr. 
F.  W.  Mott's  Address  published  in  Proceedings  of  the  Royal  Sociehj  of  Medicine, 
vol.  V,  No.  9  (Supplement). 

3  "  The  Principles  and  Practice  of  Medicine,"  1912  Edition,  p.  922. 

■♦  Vide  the  article  on  "  The  Heredity  Factor,"  post  page  45. 


SYPHILIS  29 

The  Eeport  upon  the  Census  of  1911  in  England  and  Wales  has 
recently  been  published.  There  has  been  a  steady  increase  in  the 
rate  of  insanity  since  1871,  which  has  assumed  alarming  proportions 
in  the  case  of  children  under  fifteen  years  of  age.  With  these  the 
figure  stands  at  823  per  million,  showing  an  increase  since  1871  of 
30"8  per  cent.  Taking  all  ages  together,  4,491  per  million  were 
insane,  an  increase  of  lO'l  per  cent,  since  1901.  Further,  about 
60  per  cent,  of  cases  known  to  be  syphilitic  admitted  into  asylums 
between  the  years  1908-12  were  general  paralytics.  A  serious  state 
of  things  indeed.  And  yet  we  continue  to  attempt  impossible  cures 
and  pay  no  heed  to  preventive  measures. 

The  guiding  principle  which  has  always  dictated  our  foreign 
policy  w^hen  Great  Britain  has  become  involved  in  a  war  is  that  our 
country's  frontiers  are  high-water  mark  upon  the  enemy's  coasts. 
In  other  words,  the  policy  of  sitting  quietly  at  home  and  awaiting 
attack  is  an  impossible  one  for  us.  Perhaps  we  are  apt  to  forget  the 
lessons  of  the  past  in  the  imagined  security  of  the  present ;  but  may 
not  the  analogy  be  applied  when  the  war  is  one  against  so  insidious 
an  enemy  as  sexual  disease  ? 

Syphilis  and  other  Diseases. 

We  have  seen  from  Fournier's  statistics  that  no  single  organ  of 
the  body  is  immune  from  syphihtic  attack.  But  it  is  possible  to  go 
further  and  to  assert  that  there  are  few  disorders  or  diseases  known 
to  mankind  which  may  not  be  developed,  either  directly  or  indirectly, 
from  syphilis. 

Take  tuberculosis,  for  instance,  which  is  so  much  in  the  public 
mind  at  the  present  time.  Tuberculosis,  per  se,  is  not  a  direct  out- 
come of  syphilis,  because  the  subject  must  first  become  infected  with 
the  tubercle  bacillus.  But  syphilis,  by  weakening  the  powers  of 
resistance  of  the  lungs,  renders  the  subject  more  open  to  attack  and, 
in  fact,  forms  a  very  yoioerful  predisposing  cause  to  tuberculosis.  ^ 

Especially  is  this  the  case  when  the  factor  of  heredity  is  intro- 
duced. The  child  of  a  syphilitic  father  is  extremely  liable  to 
tuberculosis.  And  so  when  we  speak  of  there  being  "  hereditary 
consumption  in  the  family,"  it  would  probably  be  discovered  that 
it  was  not  consumption  but  rather  a  disposition  to  consumption 
inherited  from,  say,  a  grandfather  who  had  contracted  syphilis. 

'  For  more  specific  details  on  tuberculosis  and  syphilis  vide  "  Syphilology," 
Dr.  C.  F.  Marshall,  London,  1906. 


30 


THE   PROBLEM   OF   THE   NATIONS 


Certain  diseases,  which  are  known  to  have  directly  originated 
in  syphilis,  are  showing  a  strong  tendency  to  increase  in  prevalence 
in  proportion  to  the  population.  Of  these  one  of  the  most 
important  is  aneurysm. 

Now  the  direct  connection  between  aneurysm  and  syphilis 
lias  been  recognized  for  at  least  200  years.  Even  before  the  dis- 
covery in  1907  of  the  Wassermann  test  for  syphilis,  medical 
practitioners  could  definitely  assert  that  90  per  cent,  of  the  cases 
of  aneurysm  had  originated  in  syphilis.^  At  the  present  time  the 
presence  of  syphilitic  poison  is  always  presumed  unless  direct 
evidence  to  the  contrary  is  forthcoming. 

A  very  large  proportion  of  the  cases  are  drawn  from  the  class 
of  "working  poor,"  especially  men  who  are  engaged  in  work 
demanding  big  muscular  effort — draymen,  for  instance,  bargees, 
iron  and  steel  workers.  And  many  of  these  men  have  served  in 
the  Army,  and  the  prevalence  of  aneurysm  seems  to  be  in  direct 
proportion  to  that  of  syphilis. 

Dr.  J.  J.  Perkins,  to  whom  I  am  indebted  for  much  valuable 
information,  has  pointed  out  to  me  that  many  of  the  disorders 
which  seem,  at  first  sight,  to  fall  under  the  heading  of  Nervous 
Disease,  are  really  some  form  of  aneurysm. 

I  append  the  returns,  recorded  by  the  Eegistrar-General,  of 
deaths  from  aneurysm  and  other  diseases  of  the  blood-vessels,  from 
1901-1911.     The  steady  increase  will  be  noticed  : — 


Year 

Deaths 

Year 

Deaths 

1901 

2,191 

1906 

3,339 

1902 

2,396 

1907 

3,652 

1903 

2,348 

1908 

3,606 

1904 

2,764 

1909 

4,285 

1905 

2,945 

1910 

4,408 

1911 

5,177 

A  similar  line  of  reasoning  may  be  adopted  in  other  diseases, 
blindness,  cancer,  and  so  on.  In  fact,  it  would  seem  that  it  is 
upon  this  point  in  particular  that  the  fullest  enlightenment  should 
be  given  to  the  community.  Since  the  discovery  of  the  Wasser- 
mann test,  we  have  come  directly  to  connect  an  ever  increasing 
number  of  diseases  with  syphilis.      So  remarkable  have  been  the 


1  "  The  infection  with  which  aneurysm  is  especially  connected  is  syphilis, 
and  nowadaj's  it  is  rare  not  to  find  a  '  positive  '  Wassermann  reaction  in  an 
anem-ysmal  patient  under  50." — "  Tlie  Princijiles  and  Practice  of  Medicine,"  Sir 
William  Osier. 


SYPHILIS  31 

results  of  the  test  that  we  may  assert  that  at  least  one-half  of 
all  disease,  if  not  a  still  larger  proportion,  is  due  more  or  less 
directly  to  syphilis.  If  gonorrhoea  be  also  taken  into  account, 
I  should  be  strongly  disposed  to  say,  from  a  careful  study  of 
the  question,  that  perhaps  tioo-thirds  of  the  diseases  known  to 
civilization  either  have  their  origin  in  sexual  disease,  or  that 
sexual  disease  is  an  important  predisposing  cause  of  them. 

Now  that  is  a  serious  statement  to  make,  but  I  will  give  some 
further  evidence  in  support  of  it.  Dr.  Carl  H.  Browning,  the 
Director  of  the  Pathological  Laboratories,  Glasgow  University,  has 
recently  carried  out  observations  upon  3,000  cases.^  In  this  work 
he  used  the  most  scrupulous  care  and  precision  of  detail  not  only 
in  aiming  at  a  complete  investigation  in  each  case  of  {a)  the  condi- 
tion of  the  patient,  {b)  the  condition  of  members  of  the  patient's 
family,  and  (c)  the  history  of  the  health  of  the  patient  and  his 
family ;  but  also  in  the  actual  working  of  the  Wassermann  test. 
This  latter  point  will  be  apprecia,ted  by  medical  men.  I  may,  how- 
ever, add  in  explanation  that  Dr.  Browning  first  of  all  thoroughly 
satisfied  himself  that  the  test  gave  what  is  called  a  "  positive 
reaction"  only  when  the  poison  of  syphilis  was  actually  present. 
Here  is  a  summary  of  the  results: — 

(1)  Amongst  331  unselected  cases  of  children  attending  hospital 
as  outdoor  patients,  syphilis  was  present  in  a  proportion  of  14 
per  cent. 

(2)  Mental  Deficiency  and  Epilepsy. — Out  of  204  cases  of  young 
people  examined,  syphilis  was  present  in  95  cases  ;  46  per  cent.  Of 
these,  105  children  were  either  under  school  age  (13  being  less  than 
5  years  old)  or  were  not  fit  to  attend  through  mental  defect.  Taking 
into  account  as  well  other  members  of  the  patients'  families,  the 
proportion  of  syphilitic  infection  was  found  to  be  59  per  cent. 

(3)  Heart  Disease  in  Children. — 25  cases  were  examined. 
Infection  was  present  in  17  and  1  doubtful,  the  ages  of  these 
ranging  from  1  month  to  3  years.  Of  the  18  cases,  9  died  when  less 
than  6  months  old. 

(4)  Deafness  in  Children. —  82  deaf  children  were  examined  ; 
17  gave  a  "  positive  "  reaction.  There  was,  further,  every  indication 
that  syphilis  plays  a  much  greater  part  in  this  condition  than  could 
be  detected  by  the  test. 

'  For  full  details  of  the  investigations  see  British  Medical  Journaly 
January  10,  1914. 


32  THE    PROBLEM   OF   THE    NATIONS 

(5)  OzcBna  (bone  diseases). — Out  of  52  cases,  16  gave  a  "  positive  " 
reaction  (30  per  cent.). 

(6)  Aortic  Disease. — Out  of  46  cases  a  "positive"  reaction  was 
present  in  64  per  cent. 

(7)  Nervous  Diseases. — 122  cases  were  examined.  A  "  positive  " 
reaction  was  given  in  41  per  cent. 

(8)  E7je  Diseases. — Out  of  84  cases  the  presence  of  syphilis  was 
indicated  in  no  fewer  than  57.  In  one  form  of  eye  disease  {inter- 
.stitial  keratitis)  the  percentage  was  95  per  cent,  of  "positive" 
reactions. 

(9)  Severe  Gynecological  Ailments  of  Women. — 37  cases  were 
examined  :  20  gave  "  positive  "  reactions,  and  2  others  had  children 
who  gave  similar  indications  of  syphilis.  Of  another  subdivision 
39  cases  were  examined  and  18  reacted  "positively,"  59  and  46 
per  cent. 

These  results  of  Dr.  Browning's  observations,  taken  in  con- 
junction with  Fournier's  statistics,  certainly  furnish  us  with  very 
weighty  evidence.  The  value  of  this  lies  not  only  in  the  actual  facts 
and  details  but  also  in  its  suggestion.  It  will  be  observed  that  a 
large  proportion  of  Dr.  Browning's  cases  were  children,  and  there- 
fore that  the  taint  of  syphilis  was  hereditary  or  congenital.  This 
fact  bears  upon  the  question  of  "  innocent "  contagion,  which  we 
have  yet  to  consider ;  also  upon  the  hereditary  effects  of  syphilis, 
which  will  also  be  dealt  with  in  due  course. 

In  attempting  to  submit  evidence  upon  this  relationship  between 
syphilis  and  other  diseases,  it  should  be  remembered  that  there  are 
no  of&cial  statistics  in  existence  to  guide  us.  At  least,  I  have  made 
diligent  search  for  some  in  many  countries,  but  without  success. 
We  have  to  depend  almost  entirely  upon  the  records  kept  by 
individuals  and  specialists,  such  as  Fournier  and  N6isser,  or  upon 
some  exceptional  series  of  observations  like  those  of  Dr.  Browning 
and  of  the  specialists  at  the  Eoyal  Army  Medical  College.  Unfor- 
tunately individual  specialists  rarely  tabulate  records  of  cases  with 
such  care  as  Fournier.  I  have  consulted  several  eminent  authorities 
upon  this  point,  but  the  information  which  I  have  been  able  to 
obtain  has  been  almost  negligible. 

I  will  take  at  random  one  or  two  more  human  disorders.  Of 
all  the  internal  organs  the  liver  is  the  one  most  prone  to  be  affected,^ 

*  '■'■  Syphilis.'"     Sir  Jonathan  Hutchinson,  p.  319. 


SYPHILIS  33 

and  jaundice  is  frequently  observed  to  be  present  in  the  early  stages 
of  syphilis.  Again  I  must  emphasize  the  fact  that  such  syphilitic 
disease  of  the  liver  is  not  confined  to  adults,  but  has  been  observed 
in  children} 

Acute  Bright's  Disease  is  often  of  syphilitic  origin. 
Syphilis,  either  in   its   inherited   form  or  in  its  secondary  or 
tertiary  periods,  very  frequently  attacks  the    larynx,   and   causes 
disorders  of  the  vocal  cords. 

Dr.  J.  Kerr  Love,  of  Glasgow,  has  estimated  that,  from  his  own 
experience,  25  per  cent,  of  cases  of  congenital  deafness  are  due  to 
syphilis.  That  this  condition  of  affairs  was  due,  amongst  the 
poorer  classes,  to  untreated  syphilis. 

Diseases  and  malformations  of  the  teeth  have  in  many  cases  been 
traced  back  to  syphilis.  Once  more  this  is  so  not  only  with  adults 
but  with  children. 

Abnormahties  in  the  growth  of  limbs  ;  dislocations  of  limbs 
from  birth^ ;  deformations  in  the  eye,  ear  and  mouth ;  rickets, 
epilepsy,  paralysis — in  fact  it  would  seem  that  it  is  only  when  one 
turns  to  diseases  like  measles,  scarlet  fever  or  mumps  that  one 
cannot  trace  any  connection  with  syphilis. 

And  yet  in  face  of  all  these  appalling  facts  we  still  go  on 
drifting.  One  is  simply  dumb  with  astonishment  that  no  practical 
measures  have  ever  been  taken  to  enlighten  the  public.  What  is 
the  use  of  publishing  articles  in  medical  journals  and  leaving  them 
there  to  be  bound  up  at  the  end  of  the  year  ?  What  is  the  use  of 
reading  papers  at  minor  Congresses,  and  passing  resolutions  which 
are  forgotten  in  a  month  ? 

The  public  will  not  listen  ?  The  subject  is  too  dreadful  ?  The 
public  must  be  made  to  listen ;  and  to  insist  that  these  Augean 
Stables  of  civilization  shall  be  cleansed. 

Sexual  disease  is  less  dangerous  than  tuberculosis  or  even  gout  if 
only  it  is  attacked  in  its  primary  stages. 

If  the  nations  can  enter  upon  a  great  campaign  against  tuber- 
culosis, which  is  far  less  serious — I  say  nothing  of  the  sequelae  of 
syphilis  and  gonorrhoea — who  will  assert  that  sexual  disease  cannot 
similarly  be  attacked  ? 

If   twenty   millions   sterling   can   be   found    to    fight    tropical 

^  Transactions  of  the  Pathological  Society,  vol.  xvi. 

'  Many  of  the  "  freaks  "  exhibited  by  Barnum  were  certainly  cases  of  hereditary 
syphilis. 

3 


34  THE   PROBLEM   OF   THE   NATIONS 

diseases  on  the  frontiers  of  the  Empire  will  there  be  no  response 
to  the  demand  when  it  is  realized  that  the  enemy  is  already  within 
oiir  very  gates  ? 

I  wonder  how  much  money  is  spent  annually  in  trying  to  convert 
the  so-called  heathen  to  Christianity.  I  wonder  how  much  time, 
money,  and  energy  is  being  wasted  over  half-a-dozen  political  and 
party  questions  of  the  day.  How  many  people  are  affected  in  any 
real  degree  by  them  ?     How  many  by  this  curse  of  civilization  ? 

What  is  the  Church  doing  towards  stemming  the  tide  of 
disease  ?  Is  it  concentrating  its  energies  upon  making  its 
adherents  a  cleaner,  healthier,  finer  body  of  men  and  women, 
of  genuine  service  to  themselves,  their  families,  and  their  country ; 
or  is  it  bent  rather  upon  nurturing  their  souls  for  the  Hereafter  ? 

The  solution  of  the  problem  lies  in  the  Education  of  the 
Individual.     What  is  being  done  to  that  end  ? 

Before  proceeding  with  the  next  section,  I  would  propose  to 
summarize  my  account  of  the  three  periods  of  syphilis  in  the  form 
of  a  short  story  taken  from  life  and  actual  facts,  names  and  localities 
only  being  altered.  "So  by  example  may  our  purpose  stand 
revealed."     I  will  call  it 

A  Lost  Leader. 

Seldom,  if  ever,  does  a  man  make  a  big  name  for  himself  during  his 
first  year  at  Oxford.  And  yet  Brentwood  proved  a  notable  exception. 
At  Charchester,  he  had  done  everything  which  a  boy  could  do  in  the 
field  and  classroom.  He  went  up  to  Oxford  with  the  biggest  reputation 
of  any  of  his  year,  and  won  a  double  blue  by  the  end  of  his  third  term. 

Brentwood  was  one  of  the  finest,  cleanest  and  straightest  young 
fellows  you  could  wish  to  meet ;  the  type,  at  its  very  best,  which  is 
directing  and  fulfilling  the  destinies  of  the  Empire  all  over  the  world. 
A  man  built  for  a  great  career.  He  was  adored  by  children  and  dumb 
animals — and  there  is  no  finer  praise. 

The  landlord  of  his  '  digs ' — in  those  days  they  were  off  the  Corn- 
market — had  a  daughter  of  twenty-two.  This  young  woman  had  already 
set  the  gossips  talking— and  not  without  cause.  Naturally  enough 
Brentwood  attracted  her  very  strongly ;  but  there  it  had  ended,  for 
Brentwood  was  a  healthy  young  fellow  with  too  many  other  things  to 
think  about ;  and  Nellie  was  not  a  particularly  pretty  girl. 

At  the  end  of  the  second  year  at  Oxford  came  his  21st  birthday  ;  and 
it  was  duly  celebrated  in  the  fashion  dear  to  Oxford.  I  should  not  say 
that  Brentwood  was  actually  drunk  when  the  party  finally  broke  up,  but 


SYPHILIS  35 

at  any  rate  he  was  merry  and  muddled— and  it  was  Nellie  who  helped 
him  to  find  his  bedroom. 

In  a  little  less  than  a  month,  he  noticed  the  appearance  of  what  he 
took  to  be  a  small  boil.  It  caused  some  little  discomfort,  but  thinking  it 
merely  an  indication  that  he  was  run  down,  a  little  out  of  sorts,  or  that 
his  blood  was  in  poor  condition,  he  paid  no  attention  to  the  sore  save 
by  consulting  a  local  chemist,  and  applying  a  boracic  acid  lotion.  It 
disappeared  in  due  course. 

Those  were  the  darkest  days  of  the  South  x\frican  War,  the  winter 
when  disaster  after  disaster  struck  chill  to  the  hearts  of  the  people,  but 
only  nerved  the  country's  manhood  to  finer  effort.  Brentwood  volun- 
teered, and  sailed  with  the  first  troop  of  Imperial  Yeomanry  to  leave 
England. 

Towards  the  end  of  the  voyage  he  began  to  feel  decidedly  ill,  with 
sick  headaches  and  intermittent  feverish  attacks,  but  he  struggled  some- 
how through  the  week  of  landing,  parades  and  movement  up  country. 

The  night  before  A  Troop  went  into  their  first  action,  Brentwood  felt 
fit  only  for  hospital.  A  week  of  drenching  rain  and  no  rest.  The  next 
day  his  troop  was  engaged  in  a  prolonged  skirmish  in  which  Brentwood 
was  badly  wounded  in  the  shoulder.  They  got  him  back  to  the  hospital 
tent,  and  then  it  was  discovered  that  he  had  developed  an  extensive  red 
rash  all  over  back  and  chest. 

The  surgeon  was  a  young  man  of  little  experience,  and  he  completely 
failed  to  diagnose  the  real  nature  of  the  symptoms.  Also  hospital  accom- 
modation and  staff  were  inadequate,  and  Brentwood  had  to  get  along  with 
little  attention.  He  got  steadily  worse,  his  skin  was  now  in  a  very  bad 
condition,  and  so  he  was  invalided  to  Cape  Town.  There  they  found 
that  he  was  well  advanced  in  the  secondary  period  of  a  bad  attack  of 
syphilis. 

But  the  mischief  was  done,  never  to  be  repaired.     That  fortnight  of 
unceasing  hard  work  in  bad  weather  with  the  grip  of  fever  upon  him,  the 
wounded  shoulder,  the  subsequent  neglect,  had  all  served  fully  to  under- 
mine a  constitution  already  weakened  by  the  insidious  poison  within  his- 
system. 

He  stayed  on  in  South  Africa  for  a  year  under  treatment  and  was 
then  pronounced  sufficiently  recovered  to  return  to  England.  But  it  was 
the  ghost  of  the  Brentwood  we  had  known  who  landed  at  Southampton, 
a  Brentwood  whom  none  of  us  recognized.  Stanmore,  Tipley  and  I  met 
him ;  and  when  he  insisted  that  he  really  was  the  dear  fellow  whom  we 
had  seen  off  from  Oxford  in  the  dark  of  a  December  morning  eighteen 
months  before,  none  of  us  could  face  him  for  the  tears  in  our  eyes. 

And  all  because  of  one  little  incident  of  which  he  had  been  at  the  time 
almost  ignorant,  almost  the  victim. 


36  THE    PROBLEM   OF   THE   NATIONS 

But  the  saddest  was  yet  to  come. 

Inevitably  prevented  from  entering  the  Diplomatic  Service,  upon  which 
he  had  set  his  heart,  too  weakened  in  health  for  continuous  concentration 
in  any  serious  work,  Brentwood  at  last  decided  to  join  a  friend  who  con- 
trolled a  large  tea-planting  estate  in  Ceylon. 

He  sailed,  leaving  his  heart  behind  in  the  keeping  of  a  charming  girl 
whom  he  worshipped.  But  he  never  told  his  love,  like  the  man  of  grit  he 
was.  And  she — she  too  loved  him,  and  wondered.  She  knows  now  ; 
and  the  shrine  of  his  memory  is  very  sacred  to  her. 

For  a  few  months  I  heard  good  accounts  of  him.  But,  almost  un- 
wittingly, the  poison  was  still  at  work  and  the  end  was  near,  though  none 
of  us  realized  how  near.  I  had  been  preparing  to  leave  for  the  Far  East 
upon  business,  when  a  cablegram  arrived  from  Brentwood  begging  me 
to  start  by  the  first  steamer. 

I  got  to  Ceylon  just  in  time  to  hold  him  in  my  arms  as  he  died.  A 
paralysis  of  certain  internal  organs  had  gradually  developed,  and  the  agony 
during  that  last  fortnight  had  been  intense.  Almost  his  last  words  were, 
"  They  say  the  woman  always  pays ;  but,  by  God,  I  think  I've  worked 
off  some  of  the  debt !  " 

So  died  one  of  the  finest  men  and  one  of  the  noblest  characters  I  have 
known.  His  country  was  immeasurably  the  poorer  for  his  loss.  He  died 
one  more  victim  to  ignorance.  His  father,  who  might  have  warned  him 
of  the  new  element,  woman,  which  would  enter  his  life  on  leaving  school, 
had  failed  to  do  so.  No  one  had  warned  him  of  possible  results,  and  these 
things  are  not  learned  by  instinct.  The  actual  incident  with  the  girl  (an 
amateur  prostitute,  be  it  noted)  might  possibly  have  happened  in  any 
case,  if  not  with  Nellie  then  with  another  ;  but  at  least  Brentwood  would 
have  been  fore-armed,  and  the  disease  would  have  been  arrested  in  its 
development. 

And  that  is  how  these  Articles  come  to  be  written. 


37 


IV. 
SYPHILIS  {continued). 

Non-sexual,  or  Innocent  Contagion. 

I  HAVE  indicated  that  a  person  may  acquire  syphilis  either  by 
sexual  intercourse  or  by  contact  with  some  infected  person  or 
article.  In  considering  this  latter  form  of  contagion  it  will  be  more 
convenient  if  we  further  qualify  those  two  divisions  and  speak  of 
syphilis  either  as  '  merited '  or  '  innocent.'  Under  the  former  will 
naturally  be  classed  the  majority  of  cases  of  the  disease,  where  con- 
tagion has  been  effected  through  what  may  be  termed  extra-marital 
intercourse.  Under  the  latter  we  may  include  those  cases  in  which 
an  individual  has  acquired  the  disease  innocently. 

As  cases  of  *  innocent '  contagion  I  would  include  {a)  wives  who 
have  contracted  the  disease  from  their  husbands  ;  (6)  children  from 
their  parents  or  nurses ;  (c)  medical  men  and  nurses  from  their 
patients;  and  {d)  generally,  those  from  infected  articles.^  These 
several  subdivisions  will  be  considered  in  due  course. 

In  these  days,  when  hardly  a  week  passes  which  does  not  see 
some  new  bogey  dangled  before  the  public  by  the  medical  or  daily 
press,  those  who  insist  upon  the  dangers  in  impure  milk,  unclean 
restaurant  dishes,  the  house-fly  and  half  a  hundred  similar  germ 
carriers,  have  come  to  be  regarded  with  an  amused  tolerance. 
'Similarly  if  I  set  forth  here  a  few  cases  of  syphilis  acquired  by  such 
-contagion,  I  shall  at  once  be  met  with  the  criticism  that  they  are 
but  isolated  cases  and  have  no  real  bearing  upon  the  prevalence  of 
the  disease. 

But  if  we  would  be  honest  in  our  endeavour  to  discover  the  rea 
meaning  and  significance  of  syphilis,  we  mustiQk.e  into  consideration 
such  cases  of  '  unmerited '  contagion.  Admit,  by  all  means,  thai 
those  cases  are  in  the  minority,  but,  in  doing  s'o,  remember  that  the 
suffering  caused  by  them  is  proportionately  greater,  because  the 

'  I  had  almost  included  in  this  division  victims  by  a  single  act  of  sexual 
intercourse,  such  as  Brentwood  in  my  story.  Why  should  a  minute  of  forget- 
fulness  be  permiitted  to  poison  a  whole  existence  ? 


38  THE   PROBLEM   OP   THE   NATIONS 

subjects  are  innocent ;  and  remember  that  the  factor  of  heredity  is 
now  at  work. 

Apart  from  the  fact  that  sexual  disease  is  not  a  topic  of  pohte 
conversation,  one  of  the  principal  reasons  why  methods  of 
prevention  have  not  been  seriously  taken  in  hand  by  national 
Governments  is  that  the  disease- is  always  presumed  to  be  due  to 
immorality.  Whenever  dej&nite  measures  have  been  advocated — and 
this  has  happened  so  many  times  within  the  last  fifty  years — they 
have  invariably  been  met  by  certain  intensely  moral  individuals  who 
have  argued  that  a  premium  would  thus  be  put  upon  vice, 

"  Sexual  disease,"  they  assert,  "is  an  admirable  corrective ;  it  is 
a  just  retribution.  Give  us  tuberculosis  or  small-pox  to  deal  with 
and  we  shall  be  most  happy  to  pass  any  Bill.  These  involve  no 
question  of  immorality ;  the  sufferers  are  all  innocent  people. 
But  sexual  disease !  If  a  man  likes  to  go  out  of  his  way  to  expose 
himself  to  infection,  and  to  seek  for  it  in  a  questionable  manner, 
then  he  must  abide  by  the  consequences." 

Such  an  attitude  as  this,  which  certainly  prevails  amongst  a  very 
large  section  of  the  public,  evinces  itself  in  many  ways,  and  not  only 
in  the  obstruction  of  State  measures.  "  It  prevents  the  charitable 
from  subscribing  towards  the  proper  cure  and  treatment  of  venereal 
diseases ;  it  influences  our  general  hospitals  through  their  lay 
committees  against  the  provision  of  accommodation  for  these 
diseases  ;  and  it  emphasizes  the  stigma  and  disgrace  attached  to  the 
inmates  of  lock  hospitals  and  the  lock  wards  in  our  Poor  Law 
institutions.  While  it  operates  as  a  deterrent  to  the  provisions  of 
proper  treatment,  it  operates  still  more  seriously  by  leading  to 
concealment  of  the  disease,  and  by  preventing  sufferers  from  seeking 
the  aid  and  advice  which  are  essential  for  their  cure  and  for  the 
prevention  of  the  spread  of  the  disease."  ^ 

Let  us  now  consider  the  argument  which  these  very  moral 
individuals  put  forward,  and,  for  the  present,  only  from  the  point 
of  view  of  non-sexual  contagion.  Let  us  see  how  far,  in  such  cases, 
sexual  disease  is  a  'just  retribution  of  sin';  and  whether,  even 
admitting  the  number  of  cases  to  be  proportionately  small,  the  facts,, 
solely  upon  their  own  merits,  do  not  warrant  some  remedial  action 
being  taken  against  the  disease  as  a  whole. 

And  again  I  must  beg  for  a  little  patience  and  indulgence  upon 

'  Eeport  on  Venereal  Diseases  to  the  Local  Government  Board,  1913. 


SYPHILIS  39 

the  part  of  the  reader,  for  specific  data  are  most  difficult  to  procure 
and  statistics  do  not  exist,  save  in  the  case-books  of  specialists  and 
institutions. 

In  the  exhaustive  observations  carried  out  by  Fournier,  and 
others  there  is,  however,  much  suggestive  material  to  be  found  ; 
nor  does  there  appear  any  need,  in  the  light  of  present-day  condi- 
tions, to  suggest  any  modification  in  his  deductions,  especially  those 
in  connection  with  this  particular  point  we  have  to  consider.  It 
is  a  curious  fact  that  these  figures  have  received  so  little  attention. 

Innocent  Contagion  in  Women. 

To  take  this  subdivision  first.  In  the  course  of  twenty-seven  years 
of  private  practice  Fournier  states  that  887  women  affected  with 
syphilis  passed  through  his  consulting  room.  These  he  distinctly 
classified  into  842  cases  where  the  disease  was  of  sexual  origin,  and 
45  where  it  was  certainly  non-sexual.  This  was  his  first  classi- 
fication, and  it  gave  a  figure  of  a  little  over  5  per  cent,  of  cases  of 
unmerited  contagion. 

He  then  carefully  considered  the  842  cases.  Bringing  his 
observations  down  to  percentage  form  Fournier  states  that  "  out 
of  100  women  affected  with  syphilis  81.  belong  to  the  demi-monde, 
or  loose  women  of  all  classes,  and  19  are  married  women." 

Thus,  adding  these  two  percentages  together,  the  figure  was 
obtained  of  nearly  25  per  cent,  as  the  average  of  cases  of  unmerited 
syphilis  in  women. 

"That   is    my  reply,"   says   Fournier,   ''  to    those   who   regard 
syphilis  as  being  necessarily  due  to  immorality." 

He  adds,  further,  that  he  had  observed  the  most  scrupulous  care 
and  impartiality  in  making  these  deductions  ;  and  that  Kicord,  his 
predecessor  and  teacher,  remarked  in  comment,  "You  have  not 
exaggerated  the  point  at  all ;  I  have  seen  the  same  as  you,  and  in 
the  same  proportions." 

Such  is  the  result  of  observations  in  Paris  upon  patients  drawn 
from  all  classes  of  society.  Have  we  any  reason  to  suppose  that  the 
facts  will  differ  materially  in  this  country  ? 

I  put  this  point  to  Mr.  J.  Ernest  Lane,  the  senior  surgeon  of 
St.  Mary's  Hospital  and  of  the  London  Lock  Hospital,  and  asked 
him  what  he  had  to  say  upon  the  subject. 

He  tells  me  that  the  most  significant  fact  of  the  present  time  ia 
that  the  majority  of  the  female  patients  whom  he  has  to  treat  are 


40  THE   PROBLEM   OF   THE   NATIONS 

very  young  girls,  mostly  under  the  age  of  20.  That  15  per  cent,  of 
the  patients  are  married  women,  and  therefore  presumably  mostly 
innocent.  "  All  the  cases,"  he  said,  "  in  the  children's  wards  and 
the  greater  part  of  the  married  women  are  cases  of  '  innocent ' 
syphilis." 

It  must  be  remembered  that  these  are  cases  passing  through  a 
public  hospital ;  that  the  observations  do  not  take  any  account  of 
the  well-to-do  classes,  the  upper  and  middle  strata  of  society,  who 
would  naturally  seek  treatment  from  private  practitioners. 

The  fact  is  of  particular  importance,  because  Dr.  T.  H.  C. 
Stevenson,  Superintendent  of  Statistics  to  the  Eegistrar-General, 
expressly  states  that  the  mortality  recorded  against  these  classes 
from  the  more  serious  syphilitic  diseases  is  high,  and  highest  of  any 
class  of  the  community  in  that  of  locomotor  ataxy.  Incidentally, 
Dr.  Stevenson  remarks  that  syphilis  appears  to  be  most  prevalent 
amongst  the  upper  and  upper  middle,  and  the  lowest  (unskilled 
labour)  classes  of  the  community. 

At  this  point  I  am  almost  tempted  to  exclaim,  "  What  need  have 
we  of  further  witnesses  ?  "  These  two  statements  by  specialists  of 
the  highest  authority  are  not  to  be  read  casually  through  and  then 
left.  Their  importance,  again,  lies  not  only  in  the  actual  facts 
recorded  but  in  their  suggestion  of  the  possible  results  arising  out 
of  the  cases  themselves. 

Bear  carefully  in  mind  what  I  have  already  said  about  the  nature 
and  characteristics  of  syphilis,  and  then  apply  some  of  those  details 
to  any  one  of  the  cases  mentioned  by  Fournier  and  Lane.  Those 
innocent  women,  and  children,  now  in  our  hospitals  are  not  being 
treated  for  a  trivial  complaint  from  which  they  will  shortly  recover 
and  face  the  world  again  completely  healed.  It  is  fairly  safe  to 
presume  that  the  majority  of  them  are  already  in  an  advanced  stage 
of  the  disease  and  that  previous  treatment,  before  they  thought  of 
entering  hospital,  was  wholly  inadequate.  Hence  their  present 
condition,  and  hence  the  increased  difficulty  in  effecting  a  total 
cure. 

And  you  must  realize  what  that  means.  It  means  that,  in  all 
probability,  for  each  case  in  the  wards  there  may  be  three  more 
outside  not  being  treated.  Apart  from  the  husband  who  has 
infected  his  wife  you  must  take  into  account  other  possible 
members  of  the  household.  The  chances  are  that  the  woman  has 
had  no  idea  how  contagious  her  disease  is.     Her  children  may  have 


SYPHILIS  41 

become  infected  by  the  mother's  kiss.  A  friend  may  have  been 
similarly  infected.  The  servant,  or  the  daily  help,  may  have  drunk 
out  of  an  infected  cup,  and,  in  her  turn,  taken  the  disease  to  her 
own  home.  You  v^ill  see  that  the  possibilities  are  simply  endless. 
And  M^hen  that  point  has  been  grasped,  then  think  what  syphilis 
actually  means,  what  it  looks  like. 

This  is  not  an  exaggeration.  I  could  tell  the  most  heart- 
rending stories  of  this  '  innocent '  contagion.  I  could  take  you  to 
Russia,  to  the  mountain-districts  of  Roumania,  to  South  America, 
to  China,  and  show  you  whole  villages  literally  decimated  by 
syphilis.  Places  where  there  is  no  such  thing  as  prostitution.  But 
this  does  not  affect  Great  Britain,  does  it  ?  A  volcanic  eruption  in 
Japan  accounting  for  5,000  deaths  is  of  far  less  interest  to 
Londoners  than  the  announcement  of  the  latest  theatrical  star's 
marriage. 

No,  sexual  disease  doesn't  really  matter !  In  any  case  it  is  all 
due  to  immorality.  We  are  not  going  to  interfere.  What  is  every- 
body's business  is  nobody's  business. 

I  wonder  what  the  good  people  of  Philadelphia  thought  about  it 
when  eight  cases  of  syphilis  occurred  through  playing  "  kiss  in  the 
ring,"  one  evening,  three  years  ago.^  But  perhaps  "  kiss  in  the 
ring"  is  an  immoral  game,  and  so  it  was  a  'just  retribution.' 

Here  is  another  case  of  '  innocent '  contagion,  recorded  by  Dr.  R. 
Ledermann,  of  Berlin.  I  give  it  in  his  own  words.  "  A  married 
man,  living  happily  with  his  wife,  and  occupying  a  good  social 
position,  was  so  unfortunate  as  to  acquire  syphilis  quite  innocently. 
In  the  third  year  after  the  infection  he  suffered  from  an  apoplectic 
seizure,  and  as  he  had  not  told  his  family  doctor  anything  about  his 
former  illness  no  specific  treatment  was  adopted.  A  permanent 
paralysis  was  the  result.  The  consequence  was  that  the  family, 
who  had  no  other  resources  but  a  small  pension,  was  thrown  from 
comparative  affluence  into  the  most  abject  poverty." 

One  could  hardly  find  a  more  striking  instance  of  the  results  not 
only  of  *  innocent '  contagion,  but  of  the  neglect  of  adequate  treat- 
ment in  the  earlier  stages  of  the  disease.  There  is  our  problem, 
again  :  To  educate  the  individual  to  go  to  the  best  available  doctor 
in  the  shortest  possible  time. 

But  I  have  not  yet  finished  with  *  innocent '  contagion  in 
married  women.      Apart  from  the  observations  of  Fournier   and 

^  Lancet,  1911,  vol.  ii,  p.  901. 


42  THE   PBOBLEM   OF   THE   NATIONS 

Lane,  and  many  other  specialists  whom  I  could  quote,  I  would  refer 
back  to  the  facts  given  in  the  previous  chapter  on  gonorrhoea.  The 
remarks  there  made  about  possibilities  of  infection  from  husbands 
apply  equally  in  the  case  of  syphilis  ;  only,  thank  heaven,  syphilis  is 
not  nearly  so  prevalent.  I  sincerely  hope  that  I  have  said  sufficient 
to  indicate  the  prevalence  of  such  contagion  and  the  possible  results. 
But  I  would  still  make  some  brief  comment  upon  two  points  in 
connection  with  syphilis  and  marriage. 

Syphilis  and  Marriage. 

There  almost  invariably  arises  considerable  difficulty  in  affording 
adequate  treatment  to  the  husband  or  wife  who  has  become  infected, 
or  in  whom  the  symptoms  develop  after  marriage.  And  the  reason 
is  the  very  natural  one  that  neither  cares  to  confess  to  the  other, 
even  if  the  gravity  of  the  disease  is  appreciated.  Consequently  a 
local  chemist  or  an  advertising  '  quack  '  is  often  consulted,  secret 
remedies  are  applied,  and  the  poison  of  the  disease  continues  at  its 
insidious  work  until  some  virulent  outbreak  or  collapse  ensues. 
This  will  perhaps  throw  a  little  more  light  upon  the  nature  of  the 
cases  in  the  hospitals  to  which  I  have  referred. 

In  married  women  the  early  symptoms  of  syphilis  are  very 
frequently  mistaken  for  those  of  some  other  ailment.'  Thus  even 
secret  remedies  may  not  be  applied  until  the  disease  has  got  a  firm 
hold.  And  I  need  hardly  add  that  in  such  secret  remedy  cases  the 
danger  of  infection  for  other  members  of  the  family  is  very  great. 

These  several  facts  probably  account  in  great  measure  for  the 
higher  statistic  percentage  of  women,  as  compared  with  men,  who 
develop  the  more  serious  disorders  of  tertiary  syphilis.  For  the 
percentage  is  higher. 

The  second  factor  in  syphilis  and  marriage  which  calls  for 
mention  is  the  more  advanced  age  of  the  individuals  concerned.  I 
mean  that  syphilis  is  more  dangerous  in  the  old  than  the  young. 
A  married  woman  of  28,  for  instance,  may  possibly  develop  graver 
symptoms  than  would  a  girl  of  19. 

It  is  obviously  impossible  in  a  work  of  this  nature  to  speak  in 
detail  upon  all  these  points.  The  question  of  syphilis  in  relation  to 
marriage  is  naturally  of  the  very  first  importance,  but  I  can  only 
attempt  to  indicate  here  that  it  is  important  and  so  leave  it  to  the 

'  Cf.  the  chapter  on  Gonorrhoea,  p.  18  supra,  also  vide  "  Health  and  Disease  in 
Belation  to  Marriage,"  Senator-Kaminer,  vol.  ii,  English  translation,  pp.  574  et  seq,. 


SYPHILIS  43:^ 

individual  to  follow  up  the  suggestion.  The  most  important  aspect 
of  the  question  is  that  of  hereditary  transmission,  and  of  this  I  have 
still  to  speak.  I  have  already  given  several  instances,  for  it  is 
difficult  to  avoid  an  overlapping  of  subjects. 

There  are  several  other  points  upon  which  I  might  well  dilate 
under  this  sub-heading.  There  is  the  question  of  syphiHs  and  Life 
Assurance,  for  instance;  a  subject  which  is  receiving  very  close 
attention  at  the  present  time  owing  to  the  relationship  which  is  now 
known  to  exist  between  syphilis  and  the  more  serious  diseases, 
paralysis,  arterial  and  cardiac  diseases,  and  so  on.  The  statistics, 
too,  to  be  obtained  through  life  assurance  societies  afford  valuable 
evidence  of  such  relationship  and  of  the  prevalence  of  sexual  disease 
itself. 

Then  there  is  the  vexed  question  of  the  duration  of  the  treatment 
which  a  syphihtic  should  undergo  before  he  thinks  of  marriage. 
That  is  a  question  which  I  shall  not  attempt  to  discuss,  because  it 
seems  to  me  that  each  individual,  in  consultation  with  his  medical 
adviser,  must  be  a  law  unto  himself. 

It  will  be  observed  that  I  have  made  no  reference  to  the 
morality  of  the  matter.  Is  it  really  necessary  to  do  so  ?  In  writing 
of  this  subject  of  sexual  disease  I  believe  that  the  best  way  to  carry 
conviction  of  its  gravity  is  to  confine  myself  so  far  as  possible  to 
simple  statements  of  fact.  If  these  will  not  convince  then  "  a  little 
bench  of  heedless  bishops  here,"  with  all  their  preaching,  would  fail. 

"  It  is  the  true  office  of  history,"  said  Bacon,  "  to  represent  the 
events  themselves,  together  with  the  counsels,  and  to  leave  the 
observations  and  conclusions  thereupon  to  the  liberty  and  faculty  of 
every  man's  judgment."  And  if  at  times  I  fall  away  from  so 
excellent  a  counsel  I  may  perhaps  be  pardoned  for  a  natural  and 
just  indignation  at  the  hideous  and  unnecessary  suffering — the 
appalling  cruelty  of  it  all ! 

I  could,  were  I  so  minded,  draw  lurid  pictures  of  families  into 
which  the  plague  of  syphilis  has  been  introduced  by  the  husband. 
To  a  pure-minded,  virtuous  woman  syphilis  is  a  loathsome  thing, 
a  thing  belonging  to  debauch  and  loose  women.  It  needs  little 
imagination  to  conjure  up  the  results  when  It  has  crept  into  the 
home.  I  recall  a  case  where  the  wife,  after  two  miscarriages,  gave 
birth  to  a  child  infected  with  syphilis  which  died  almost  im- 
mediately. Then  the  revelation  of  the  disease  came  upon  her  in  a 
lightning  flash,  she  realized  that  her  husband  was  the  murderer  of 


44  THE    PKOBLEM   OF   THE   NATIONS 

her  three  children.  Mad  with  grief  and  hate  she  stabbed  him  to 
the  heart,  and  then  killed  herself. 

Certainly  this  was  an  exceptional  tragedy,  but  the  case-books  of 
private  practitioners  will  furnish  hundreds  of  narratives  of  lesser 
tragedies — of  divorce,  social  ruin  and  all  the  attendant  miseries  to 
husband,  wife  and  children. 

Syphilis,  during  the  active  period  of  life,  does  not  as  a  rule  lead 
to  sterility  in  the  wife,  but  it  is  estimated  that  42  per  cent,  of 
miscarriages  and  abortions  are  due  to  the  disease.  With  both 
parents  infected  the  proportion  is  so  high  as  70  per  cent. 

Proper  treatment  will  hold  syphilis  in  abeyance  even  if  it  does 
not  actually  cure  it.  From  careful  comparison  of  results  the  broad 
rule  has  been  established  that : — without  adequate  treatment  abor- 
tion will  result ;  with  proper  treatment  there  will  be  healthy 
children ;  but  when  the  treatment  ceases  there  will  be  syphilitic 
children.^ 

It  is  asserted  that  the  elimination  of  sexual  disease  will  put  a 
premium  upon  immorality.  Even  supposing,  for  the  sake  of 
argument,  that  it  will,  what  have  we  to  say  for  the  20  to  25  women 
out  of  a  hundred,  to  say  nothing  of  the  children,  who  are  innocently 
condemned  to  such  suffering  ?  Have  they  no  claims  upon  our  sense 
of  justice  ? 

And  yet,  with  all  that  I  have  said  about  these  tragedies  of 
'  innocent '  contagion,  I  would  again  emphasize  the  fact  that,  with 
the  sterling  remedies  which  are  now  at  command,  sexual  disease  is 
less  serious  thafi  tuberculosis  if  only  treatment  is  secured  and  persisted 
in  from  the  very  beginning.    It  depends  upon  the  individual. 


'  Address  by  Dr.  C.  W.  MacGillivray  to  the  Edinburgh  Medico-Chirurgical 
Society,  January  5,  1910. 


45 


V. 

SYPHILIS  (conti7iued). 
Non-sexual,  oe  Innocent  Contagion  (continued).. 
Children  and  the  Heredity  Factor. 

"The  world  has  no  such  flower  in  any  land, 
And  no  such  pearl  in  any  gulf  the  sea. 
As  any  babe  on  any  mother's  knee." — Swinburne. 

"  "Where  children  are  not,  heaven  is  not." — Swinburne. 

I  HAVE  now  to  speak  of  the  most  cruel  aspect  of  all  this 
harrowing  subject.  Not  only  the  most  cruel,  but  the  most  signi- 
ficant in  our  consideration  of  the  causes  and  effects  of  sexual 
disease.  The  question  of  the  innocent  infection  of  children,  and 
its  hideous  results,  is  so  inextricably  woven  into  the  subject  of 
'  hereditary  transmission '  that  it  seems  best  to  take  both  aspects 
under  one  sub-heading.  Again  I  must  attempt  to  set  forth  the 
facts  with  as  little  comment  as  possible,  for  I  dare  not  trust  myself 
further. 

I  will  begin  with  two  authoritative  quotations : — 

"  If  I  were  asked,  as  an  old  practitioner,  what  is  the  worst  result 
of  syphilis,  I  should  have  no  hesitation  in  replying  that  it  is  the 
hereditary  effect,  which  manifests  itself  by  causing  hecatombs  of 
infants,  without  any  exaggeration." — Foueniee. 

"  Syphilis  is  the  hereditary  disease  par  excellence.  Its  hereditary 
effects  are  more  inevitable,  more  multiple,  more  diverse,  and  more 
disastrous  in  their  results  on  the  progeny  and  the  race  than  in 
the  case  of  any  other  disease.  Syphilis  has,  in  fact,  a  more 
harmful  influence  on  the  species  than  on  the  individual." — 
Dr.  C.  F.  Maeshall. 

Speaking  in  a  general  sense,  the  unborn  babe,  or  the  child  after 
birth,  may  become  infected  with  the  poison  of  syphilis  in  one  of 
three  ways,  which  may  be  further  subdivided : — 

(1)  By  hereditary  transmission.     This  means  either  {a)  that  tha 


-46  THE   PROBLEM   OF   THE   NATIONS 

(potential)  mother  is  already  infected  with  the  poison  before  the 
child  is  actually  conceived,  or  (6)  that  the  father  transfers  the  poison 
to  the  mother  in  the  spermatozoa. 

(2)  By  conge?iital  transmission.  This  means  that  the  unborn 
child  has  been  conceived  in  a  healthy  condition,  but  has  become 
infected  either  before  or  at  birth  from  the  infection  of  the  mother 
subsequent  to  conception. 

(3)  By  contagion  after  birth.  That  is  when  a  healthy  child  is 
born,  but  the  disease  is  subsequently  acquired  from  an  infected 
parent,  a  nurse,  or,  generally,  from  an  infected  article. 

Taking  (1)  and  (2)  we  come  to  speak  of  *  transmission '  as  being 
either  (a)  Mixed,  from  both  parents ;  or  (b)  Maternal,  which 
includes  infection  from  the  mother  either  at  conception  or  during 
pregnancy  ;  or  (c)  Paternal,  where  the  mother  is  healthy,  but  the 
poison  is  conveyed  as  noted  in  (1),  6.  ^ 

It  may  be  urged  that  these  exact  details  appear  unnecessary  in 
a  work  of  this  character.  But  a  moment's  thought  will  reveal  the 
importance  of  making  such  a  differentiation.  Let  me  instance  a 
case  of  congenital  transmission  which  recently  came  under  my  own 
notice. 

A  married  couple  were  perfectly  healthy.  The  wife  became 
pregnant.  In  the  course  of  this  period  the  husband,  who  was 
devoted  to  his  wife,  was  led,  under  the  influence  of  boon  com- 
panions, a  cheery  supper  and  over-much  champagne,  to  indulge 
in  extra-marital  intercourse.  He  became  infected  with  syphilis, 
which  he  did  not  recognize  as  such,  and  subsequently  infected  his 
wife.  Five  months  later  a  child  was  born.  It  died  before  it  was 
a  year  old. 

Here  is  another  instance  of  what  may  occur  through  paternal 
transmission.  The  mother  was  quite  healthy,  but  the  father  had 
a  latent  syphihs.  He  infected,  not  his  wife,  but  the  child  to  be 
in  the  manner  indicated  above.  The  wife  remained  uninfected 
until  the  moment  of  giving  birth  and  then  became  infected  from 
her  babe. 

I  have  mentioned  these  two  cases,  which  will  naturally  suggest 

'  It  should  be  remarked  that  there  is  considerable  controversy  on  the  subject 
of  paternal  transmission,  but  the  weight  of  evidence  and  expert  opinion  is 
decidedly  in  favour  of  its  frequent  possibility.  Eeference  may  be  directed  to  a 
Paper  on  the  subject  by  Dr.  C.  F.  Marshall,  Journal  of  Children's  Diseases, 
vol.  ix,  p.  204. 


SYPHILIS 


47 


a  further  endless  variety,  because  I  think  that  the  pubhc  should 
realize  something  of  the  manner  in  which  the  child  may  become 
infected.  It  will  readily  be  understood  that  hereditary  transmission 
is  by  far  the  most  harmful  in  its  effects,  because  the  child  is  actu- 
ally conceived  in  a  state  of  infection.  Fournier  estimated  that 
the  morbidity,  or  prevalence  of  disease,  due  to  mixed  transmission 
was  92  per  cent.,  and  the  death-rate  amongst  such  infants  68"5  per 
cent.  The  morbidity  from  maternal  transmission  he  estimated  at 
84  per  cent.,  and  the  death-rate  at  60  per  cent.  From  'paternal 
transmission  the  morbidity  was  37  per  cent,  and  the  mortality 
28  per  cent.  It  will  also  be  realized  that  the  results  must  differ 
according  to  the  state  of  development  of  the  foetus  at  the  time  of 
infection.^  For  instance,  as  a  result  of  hereditary  transmission, 
there  may  be  a  definite  cessation  of  development  of  the  foetus,  or 
of  particular  limbs  or  organs.  Conge^iital  transmission  may,  on 
the  other  hand,  produce  only  some  of  the  specific  symptoms  of 
syphilis. 

I  do  not  wish  to  dwell  upon  this  part  of  the  subject  longer  than 
is  necessary,  but  it  seems  well  to  clear  the  ground.  What  I  desire 
to  emphasize  at  this  point  is  the  appalling  child  mortality  which 
results  from  infected  parents.  The  above  percentage  figures  give 
some  indication  of  this,  and  I  would  invite  a  very  thoughtful 
attention  to  them.     Let  me  set  them  down  in  tabular  form  : — 


Mode  of  transmission 

Syphilis  present  in 

Death-rate 

Mixed            

Maternal 
Paternal 

92  per  cent. 
84        „ 
37        „ 

68 "5  per  cent. 

60 

28 

Take  only  the  least  dangerous  of  those  subdivisions,  that  of 
paternal  transmission.  There  we  find  that  children  born  from  an 
infected  father  and  a  healthy  mother  die  in  the  proportion  of 
1  in  4.  But  look  at  the  figures  of  mixed  and  maternal  trans- 
mission. They  are  almost  too  terrible  to  reahze.  It  has,  in  fact, 
been  laid  down  as  an  axiom  that  a  child  born  of  a  mother  in  a  state 
of  recent  infection  is  almost  fatally  condemned  to  death. 


Syphilology,"  Dr.  C.  F.  Marshall,  p.  318. 


48  THE   PROBLEM   OF   THE   NATIONS 

The  case-books  of  an  eminent  specialist  in  private  practice'  record 
the  history  of  44  women  who  became  pregnant  in  a  state  of  infec- 
tion.    Of  the  44  births  there  were  43  deaths  and  one  living  child  ! 

The  same  specialist  also  records  208  births  from  100  infected 
women.  Of  these  60  only  survived.  The  remainder  were  mis- 
carriages or  stillbirths.  A  mortality  of  71  per  cent.  !  And  all  of 
these  cases  were  drawn  from  the  upper  and  middle  classes,  to  whom 
the  best  medical  care  was  open,  and  who  may  have  been  presumed 
to  possess  a  reasonable  amount  of  intelligence  and  knowledge. 
Imagine  the  figure  in  the  case  of  the  lower  classes.  In  fact,  at  the 
Lourcine  Hospital,  Paris,  the  mortality  reached  the  figure  of  86  per 
cent.,  and  at  the  St.  Louis  Hospital,  where  the  patients  are  of  a 
somewhat  better  class,  the  figure  is  84  per  cent. 

Another  set  of  cases  was  that  of  90  women,  infected  by  their 
husbands,  who  became  pregnant  during  the  first  year  of  the  disease. 
The  births  resulted  as  follows :  Fifty  miscarriages  or  stillbirths, 
38  deaths  shortly  after  birth,  and  two  infants  who  survived.  A 
death-roll  of  88  out  of  90.  Again  all  these  cases  were  drawn  from 
the  higher  classes  of  society,  and  observed  in  the  course  of  private 
practice. 

It  is  of  the  first  importance  to  note  that  these  three  series  of 
observations  were  taken  in  the  ordinary  course  of  practice  ;  that 
there  was  no  idea  of  selecting  a  number  of  malignant  cases  with 
a  view  to  making  a  pessimistic  return.  The  figures  were  compared 
with  the  results  obtained  by  some  fifteen  other  specialists,  and  the 
outcome  was  practically  identical,  the  mortality  averaging  77  per 
cent. 

Still  further  confirmation,  if  any  were  desired,  is  to  be  found 
in  the  statistics  published  in  1911  by  Dr.  Leroux,  as  the  results 
of  his  observations  made  at  the  Furtado-Heine  Dispensary,  Paris.^ 
These  percentage  returns  and  figures  work  out  as  almost  identical 
with  those  quoted. 

Dr.  Hochringer,  of  Vienna,  published  in  1910  the  results  of 
his  observations  at  the  Children's  Hospital  in  that  city.^  He 
records  that  out  of  516  births  from  syphilis-infected  parents  253 
were  born  dead  or  died  soon  after  birth.  Of  the  263  survivors 
55  died  before  the  age  of  4,  despite  careful  treatment ;  and  of  the 

^  "  The  Prevention  of  Syphilis,'"  Alfred  Fournier. 

'  "  Annuaire  cle  Medecine  et  Chirurgie  Inf.,''  Paris,  1911,  xv,  p.  337. 

^  Munch.'med.  Woch.,  1910,  p.  Ivii,  1156. 


SYPHILIS  49 

remaining  208  only  51  were  normally  healthy.  Once  again  then 
we  find  a  similar  percentage,  only  about  25  per  cent,  of  syphilis 
infected  children  growing  into  healthy  adults. 

In  fact,  in  every  country  from  which  I  have  gathered  informa- 
tion, the  story  is  the  same.  I  have  already  referred  to  the  preva- 
lence of  the  disease  in  certain  villages  in  Russia  ;  I  will  quote  from 
two  more  authorities  in  that  country. 

A  careful  record  was  kept  in  Moscow  for  a  period  of  ten  years. 
During  that  time  there  were  recorded  2,002  births  from  syphilis- 
infected  parents.  Of  this  number  only  577  children  survived.  A 
mortality  of  71  per  cent.  ! 

Dr.  Tarnowsky  records  a  case  of  three  famihes  with  22  children. 
Of  all  these  individuals  only  one  healthy  adult  survived. 

Major  H.  C.  French,  E.A.M.C,  records  his  personal  experience 
of  a  similar  condition  of  affairs  in  India  between  the  vears  1896 
and  1901. 

Dr.  Bennie  ^  gives  evidence  in  support  of  his  theory  that  every 
child  possesses  a  syphilitic  taint  if  either  parent  has  ever  had 
syphihs.  He  adds  that  of  Australian  children  10  per  cent,  are  so 
infected,  and  that  for  these  the  chances  of  death  before  puberty 
are  seven  times  as  great  as  in  the  case  of  normally  healthy 
children. 

Infant  Mortality  in  Great  Britain. 

This  last  statement  naturally  suggests  a  consideration  of  the 
state  of  affairs  in  Great  Britain  ;  a  comparison  with  other  countries. 
Here  I  must  honestly  confess  that  I  am  at  a  loss.  Data  upon  the 
general  prevalence  of  syphilis  in  this  country  are  both  meagre  and 
unreliable,  and  still  more  so  upon  the  question  of  infantile  mortality 
from  the  disease.  For  instance,  in  the  Eeports  to  the  Local 
Government  Board,  1900-1910,  1912-1913,  upon  Infant  Mortality 
in  England  and  Wales,  sexual  disease  is  not  even  mentioned. 

"We  English,"  said  Mr.  H.  A.  Jones  in  one  of  his  plays,  ''are 
no  better  than  our  neighbours,  but,  thank  heaven,  we  do  pretend 
to  be."     The  remark  seems  rather  a  propos. 

In  view  of  the  facts  which  I  have  quoted  have  we  any  just 
grounds  for  presuming  that  we  are  any  better  than  our  neighbours 
in  respect  to  infant  mortality  from  syphilis  ?  Why  should  we 
presume  that  we  are  ?     For  the  moment  I  am  trying  to  consider 

'  Writing  in  the  Intercollegiate  Medical  Journal  of  Australia,  March  20, 1909. 
4 


50  THE   PROBLEM   OF   THE   NATIONS 

"infant  mortality"  apart  from/' general  prevalence,"  althougli  it 
is  difficult  to  do  so. 

Taking  the  Registrar-General's  Annual  Eeports  for  the  years 
1906-1911  we  find  that  the  average  number  of  deaths  frovi  syphilis 
alone  of  the  whole  population  is  1,709.  Now  three-fourths  of  this 
figure  represents  infant  mortality  (i.e.,  under  one  year  of  age),  or  an 
average  number  each  year  of  1,282  deaths  of  infants  from  syphilis. 

As  the  population  of  England  and  Wales  in  1911  was  returned 
at  36,000,000,  this  death-rate  is  not  very  startling,  although  it 
should  be  noted  that  the  birth-rate  has  been  steadily  declining  since 
1895  in  proportion  to  the  increase  of  the  population  :  i.e.,  from  29*4 
per  1,000  in  1895  to  24-0  in  1912. 

In  Ireland  the  records  show  that  syphilis,  per  se,  plays  a 
relatively  small  part  as  a  cause  of  mortality,  the  figure  being  0"78 
per  10,000  of  the  total  population.  In  Dublin  the  figures  are 
abnormally  high,  being  double  those  of  London. 

The  official  returns  of  infant  mortality  from  syphilis  alone  for 
the  United  Kingdom  are  : — 1-29  per  1,000  for  England  and  Wales  ; 
1-4  for  Scotland  ;  and  0'59  for  Ireland. 

Dr.  J.  Kerr  Love  recently  recorded  his  observations  upon 
twenty-one  families  infected  with  syphihs.  Two-thirds  of  the 
children  were  born  dead,  or,  if  alive,  were  blind  or  deaf  or  both. 

But,  as  we  have  seen,  syphilis  is  an  elastic  term.  When  we 
find  recorded  that  so  many  infants  died  of  syphilis,  it  means  that 
obvious  syphilitic  symptoms  were  present.  It  does  not  include  any 
of  those  many  other  diseases  from  which  children  suffer  as  a  more 
or  less  direct  result  of  hereditary  or  congenital  syphilis.  And  if 
you  will  refer  back  for  a  moment  to  Dr.  Browning's  investigations 
on  p.  31,  you  will  see  what  some  of  those  diseases  are.  For 
instance,  of  the  eighteen  cases  of  heart  disease  nine  died  under  the 
age  of  six  months. 

However,  in  order  to  give  some  general  indication  of  the  rate  of 
infant  mortality  due  to  some  of  these  diseases  I  will  set  down  some 
figures  taken  from  the  last  Annual  Eeport  of  the  Registrar-General 
for  England  and  Wales,  that  for  1911.  I  may  add  that,  exclusive 
of  diarrhoea  mortality,  the  rate  for  1911  was  only  2  per  1,000  in 
excess  of  that  for  1910,  the  lowest  until  then  recorded.  It  will  be 
noted  that  I  have  included  the  death  rate  of  illegitimate  infants, 
for  some  of  these  figures  are,  by  comparison,  particularly 
instructive  : — 


SYPHILIS 
Peoportion  of  Deaths  under  1  year  to  1,000  Births. 


51 


Cause  of  death 

All  infants 

Legitimate 
infants 

Illegitimate 
infants 

Tuberculous  diseases 

3-81 

3-66 

7-20 

Developmental  and  toasting  diseases   . . 

41-37 

39-60 

81-07 

Laryngitis 

0-20 

0-20 

0-24 

Syphilis     .. 

1-29 

0-99 

8-10 

Rickets 

0-39 

0-36 

1-09 

Congenital  malformations 

3-68 

3-67 

3-85 

Premature  birth  . . 

20-10 

19-47 

34-23 

Atrophy,  debility  and  marasmus 

15-90 

14-80 

40-68 

Further  than  this  I  feel  I  cannot  go.  Where  the  Koyal  Com- 
mission has  failed  in  obtaining  evidence  it  is  hardly  likely  that  I 
should  succeed.  Syphilis  is  not  a  notifiable  disease,  and  it  is  a 
surprising  fact,  not  that  the  number  of  recorded  deaths  should  be 
so  few  but  that  they  should  be  so  numerous.  For  it  can  be  only 
in  exceptional  cases  that  syphilis  is  actually  recorded  as  the  cause 
of  death.  And  I  shall  be  confronted  with  the  same  difficulty  in 
speaking  of  general  prevalence.  In  writing  of  this  subject  of  sexual 
disease  I  prefer,  as  far  as  possible,  to  set  forth  definite  facts  rather 
than  hypothetical  suggestions. 

But  before  leaving  this  brief  consideration  of  infant  mortality 
I  would  once  again  emphasize  the  beneficial  effects  which  come 
from  early  and  adequate  treatment. 

We  have  seen  that  the  gravest  danger  arises  during  the  first 
year  of  the  parents'  infection ;  the  "  year  of  terror,"  as  Fournier 
terms  it.  But  from  this  period  the  danger  gradually  decreases, 
although  it  depends  to  a  large  extent  upon  the  action  of  the 
individual.  Thus,  at  the  outset,  we  find  abortions ;  then  still- 
births ;  then  living  children  in  whom  symptoms  of  syphilis  may 
develop  at  any  time  ;  and,  lastly,  healthy  children. 

And  even  this  progression  is  modified.  For  with  thorough 
treatment  there  seems  no  reason  why  there  should  not  be  healthy 
children  from,  say,  the  second  or  third  year.^  It  depends  upon  the 
individual. 

Finally,  medical  science  is  concentrating  every  effort  to  combat 
the  effects  of  the  disease  upon  the  unborn  child,  and  already  the 
salvarsan  treatment  has  secured  good  results  in  this  direction.' 

^  Vide  p.  44  supra,  for  the  axiom  upon  this  point. 

^  This  upon  the  authority  of  Dr.  Jeanselme,  of  the  Broca  Hospital,  Paris, 
one  of  the  first  medical  men  in  France  to  use  Ehrlich's  remedy. 


52  ♦  THE   PROBLEM   OF   THE   NATIONS 

Hereditary  Symptoms  in  Children. 

Ill  speaking  of  innocent  contagion  of  children  I  have  dealt  so 
far  solely  with  effects  upon  mortality.  We  have  now  to  consider 
very  briefly  the  effects  of  syphilis  upon  living  children.  And  then 
I  hope  to  have  finished  with  this  most  painful  part  of  the  subject. 
I  may  add  that  for  my  authorities  upon  this  question  I  rely  chiefly 
upon  the  records  and  observations  of  Professor  Fournier,  Sir 
Jonathan  Hutchinson,  Dr.  C.  F.  Marshall,  and  others  who  will 
be  indicated. 

For  the  sake  of  convenience  I  will  adopt  Fournier's  summary,  in 
three  groups : — 

(1)  The  symptoms  which  affect  the  individual  in  a  partial 
manner  only,  i.e.,  the  part  of  a  system,  or  a  single  organ. 

(2)  Those  affecting  the  body  as  a  whole. 

(3)  Those  which  are  still  more  serious,  and  constitute 
monstrosities. 

As  regards  the  third  subdivision,  which  is  comparatively 
uncommon,  I  think  it  unnecessary,  for  obvious  reasons,  to  speak. 
And  surely  we  have  "  supped  full  with  horrors." 

The  ordinary  symptoms  of  syphilis  are,  for  the  most  part, 
absent  in  infected  children.  The  effect  of  the  poison  manifests 
itself  in  such  ways  as  malformations  of  the  teeth  (which  are 
particularly  common)  and  palate ;  of  the  head  and  skull ;  of  the 
spine,  nose,  eyes  and  ears ;  of  the  limbs,  such  as  dislocations  of 
the  hip,  club-foot,  &c.  ;  and  in  disorders  of  the  heart,  &c.  All 
these  are  included  under  the  first  subdivision. 

I  do  not  propose  to  go  into  further  details,  for  they  would  be  too 
horrible.  The  finest  object-lesson  for  anyone  who  doubts  the 
hideous  effects  of  syphilis  upon  children  would  be  a  visit  to  the 
London  Hospital  and  an  inspection  of  half  a  dozen  cases  of  children 
ranging  from  8  to  1.5  years  old.-^  I  can  assure  such  a  visitor  that 
the  nightmare  would  haunt  him  to  his  dying  day. 

But  the  public  does  not  see  such  things,  they  are  guarded  by 
hospital  walls.    And  so  we  go  on  in  our  smug  complacency,  drifting, 
drifting.     "  God's  in  His  heaven — All's  right  with  the  world  !  " 
"  But  the  young,  young  children,  0  my  brothers, 
They  are  weeping  bitterly  ! 
They  are  weeping  in  the  playtime  of  the  others, 
In  the  country  of  the  free." 

1  For  anyone  who  dares  to  brave  some  details  and  photographs  he  wiU  find 
them  in  the  Lancet  of  January  3,  1914 ;  five  cases  recorded  by  Dr.  J.  H.  Sequeira. 


SYPHILIS  53 

Under  the  second  subdivision  are  included  cases  where  the 
general  constitution,  temperament  or  vital  resistance  is  affected  ; 
where  the  child  is  born  "  a  weakly,  puny,  wizened  creature,"  too 
weak  to  suck  or  cry.  Or  it  may  be  brought  to  life  seemingly 
healthy  and  may,  in  a  few  years,  be  carried  off  because  it  does  not 
appear  to  have  the  will  to  live  ;  dying  of  no  definite  complaint,  just 
passing  away. 

Another  tj^pe,  under  this  subdivision,  is  the  child  whose 
physical  development  is  permanently  arrested  ;  a  stunted  growth 
like  that  of  a  Japanese  dwarf  tree,  and  yet  growing  older,  ever  older. 

Then  there  is  this  question  of  Mental  Deficiency  in  children. 
Some  observations  of  the  first  importance  on  the  subject  have 
recently  been  carried  out  by  Dr.  Kate  Fraser  and  Dr.  H.  Ferguson 
AVatson,  upon  204  cases  of  mentally  deficient  children,  ranging 
from  1  month  to  8  years  old. 

In  the  great  majority  of  cases  there  were  no  palpable  traces 
whatever  of  syphilis,  even  when  an  examination  of  the  parents 
and  relatives  gave  practically  conclusive  evidence  that  it  must  be 
present. 

Of  these  204  cases  the  presence  of  syphilis  was  detected,  by  the 
Wassermann  test,  in  no  fewer  than  60  per  cent. 

Summing  up,  these  specialists  concluded  that  syphilis  was  the 
causative  factor  in  more  than  50  per  cent,  of  cases  of  tnental 
deficiency ;  and  that  syphilis  was  associated  with  a  far  higher 
percentage  of  cases  than  could  be  ascertained  by  an  examination 
of  the  patients  alone. 

Rickets,  in  children,  is  also  closely  allied  to  hereditary  syphilis. 
Dr.  Pinard,  of  Paris,  states  that  he  had  never  observed  a  case  of 
rickets  apart  from  heredo-syphilis. 

Infected  children  are  also  especially  liable  to  Convulsions,  and 
so  to  serious  brain  diseases. 

Now  it  will  be  seen  how  valueless  are  our  statistics  of  infant 
mortality  due  to  syphilis.  Apart  from  deaths  due  to  all  the 
hundred  and  one  distinct  manifestations  of  the  poison  of  which 
statistics  take  no  account  as  such,  we  have  no  record  of  these 
thousands  of  cases  (there  must  be)  of  death  in  life. 

Who  shall  tell  the  tale  of  the  children  who  linger  on  in  physical 
and  mental  agony,  looking  out  with  wide-wondering  eyes  upon 
the  life  which  their  brothers  and  sisters  find  so  full  of  sunshine. 
Shall  they  not   at   the  last   call  their  parents   before  the  Bar  of 


54  THE    PROBLEM   OF   THE    NATIONS 

Judgment  and  demand  the   reason    of    their   summons    into    the 
world  ! 

And  the  parents  ■will  answer,  "  We  didn't  know ;  we  didn't 
realize  "  ! 

The  excuse  may  have  served  ;  let  us  see  to  it  that  it  shall  serve 
no  longer.  If  there  is  anything  in  all  this  ghastly  subject  which 
can  awaken  the  conscience  of  the  nation — no,  the  conscience  of 
civilization — surely  it  must  be  the  cry  of  the  children. 

I  read  in  the  press  of  a  public  meeting  held  to  protest  against 
the  action  of  the  head-mistress  of  a  school  in  daring  to  instruct  her 
pupils  in  the  elements  of  sex  hygiene.  I  read  the  comment  of  a 
worthy  town  councillor  at  that  meeting,  "  We  don't  want  our 
children  to  be  educated  as  midwives." 

Have,  then,  those  parents  who  thronged  the  hall  been  at  pains 
themselves  to  instruct  their  children  in  the  things  which  a  child 
should  learn,  and  in  the  most  beautiful  manner  ?  Have  they 
fulfilled  their  obligations  in  such  a  way  that  they  may  properly 
resent  interference  from  a  third  person  ? 

Oh  !  this  miserable  hypocrisy  and  cant ;  are  we  never  going  to 
break  it  down? 

But  it  has  to  be  broken  down,  and  this  generation  is  going  to 
do  it.  I  refuse  to  believe  that  the  public  will  not  respond  so  soon 
as  it  has  learned  the  facts.  There  must  be  initiated  such  a  cam- 
paign of  education  as  will  break  up  once  and  for  all  this  conspiracy 
of  silence.  That  campaign  has  indeed  already  been  begun  and 
recruits  are  enrolling  themselves  by  hundreds  in  the  ranks  of  the 
invading  army.  Let  the  watchword,  "  For  the  Children,"  be 
emblazoned  upon  its  standard,  to  be  carried  like  a  fiery  cross 
to  the  confines  of  the  world. 

"  Do  you  hear  the  children  weeping,  O  my  brothers, 
Ere  the  sorrow  conies  with  years  ?  " 


55 


VI. 

SYPHILIS  {continued). 
Innocent  Contagion  {continued). 

Nurses  arid  Infants. 

Leading  directly  out  of  the  contagion  of  children  we  may 
suitably  consider  a  few  facts  concerning  the  infection  of  nurses  by 
infants ;  also  the  converse,  the  suckling  of  healthy  children  by  an 
infected  nurse. 

Particular  attention  has  recently  been  directed  to  this  question 
by  the  production  of  Brieux's  play,  "Les  Avaries "  ("Damaged 
Goods").  In  this  there  is  an  episode  where  the  medical  attendant 
forbids  the  suckling,  by  a  healthy  nurse,  of  a  child  in  whom  syphi- 
litic symptoms  have  developed. 

It  will  at  once  be  apparent  how  very  real  this  danger  must  be. 
The  danger  is  immediate  when  the  symptoms  have  already 
developed  ;  but  it  also  exists  in  the  numerous  cases  in  which  the 
child  remains  apparently  healthy  for  some  time  after  birth.  Pinard 
gives  statistics  showing  that  symptoms  appear  in  infants  :  in  70 
per  cent.,  during  the  first  month  ;  in  20  per  cent,  during  the  second 
month  ;  and  in  10  per  cent,  up  to  the  end  of  the  fourth  month. 
Thus  a  child  born  of  syphilitic  parents  cannot  be  held  non-contagious 
during  this  period. 

The  subject  is  one  which  presents  considerable  difficulties  to 
the  medical  attendant,  and  Brieux  has  well  indicated  these  in  his 
plaj^  Without  going  into  the  point  at  length  the  alternatives  may 
be  briefly  stated. 

The  main  point  to  be  decided  is  the  one  considered  by  Brieux — 
whether  the  first  duty  is  due  to  the  infected  infant  or  to  the 
healthy  nurse.  If  the  infant  is  deprived  of  its  natural  food  given 
by  the  natural  method  then  it  will  undoubtedly  suffer.  On  the 
other  hand  the  nurse  will  become  infected  and  will,  in  all  pro- 
bability, spread  the  contagion.  Here  are  two  cases  in  point 
quoted  by  Fournier  : — 


56  THE    PROBLEM   OF   THE    NATIONS 

(1)  A  child  born  of  a  syphilitic  father  was  given  to  a  healthy 
nurse.  The  child  soon  developed  symptoms  of  syphilis  and  infected 
the  nurse.  The  latter,  in  turn,  infected  her  husband,  who  lost  an 
eye  by  syphilitic  iritis.  The  nurse  died  soon  afterwards  of  syphilitic 
paralysis. 

(2)  A  husband  infected  his  wife,  and  the  child  subsequently 
born  was  given  to  a  nurse.  The  child  developed  symptoms  of 
syphilis  and  infected  the  nurse.  The  nurse,  in  turn  infected  her 
own  child,  which  died  in  a  few  months,  and  also  her  husband. 
The  nurse  also  lost  an  eye  through  syphilitic  iritis,  and  a  year 
later  gave  birth  to  a  syphilitic  child,  which  died  in  two  months. 

From  these  and  other  similar  considerations  the  rule  must  be 
established  that  '  we  have  not  the  right  to  give  syphilis  to  a  nurse 
in  order  to  save  an  infant.' 

There  are  many  other  issues  involved  in  this  question  andi 
Fournier  has  dealt  with  them  in  detail.^ 

I  will  quote  one  case  to  show  the  converse  side,  viz.,  the 
infection  spread  by  a  syphilitic  nurse.  It  will  be  noted  that  nearly 
all  the  cases  which  are  given  throughout  this  work  bear  upon 
several  other  points  in  addition  to  the  one  immediately  at  issue. 
AVhile  the  details  are  invariably  unpleasant  I  think  that  definite 
examples  of  the  effect  of  syphilis  will  have  more  practical  value 
than  mere  descriptive  writing. 

A  healthy  child,  of  some  8  months,  born  of  young  and  healthy 
parents,  was  given  to  a  strong  and  apparently  healthy  nurse.  In 
about  six  weeks  the  nurse  developed  certain  symptoms  which  were 
subsequently  diagnosed  as  syphilitic.  (It  was  afterwards  discovered 
that  she  had  been  undergoing  treatment  for  syphiHs,  and  that  her 
child  had  died  of  the  disease.) 

The  child  began  to  waste  and  developed  sores  in  the  mouth, 
followed  by  other  and  more  serious  secondary  symptoms.  The 
mother  contracted  a  chancre  on  the  lip  through  kissing  the  child  ; 
and  this  was  followed  by  secondary  symptoms,  and  a  subsequent 
abortion. 

The  grandmother  also  contracted  the  disease  about  the  same 
time  as  the  mother ;  as  did  also  two  sisters  of  the  child,  ail 
developing  secondary  symptoms. 

Finally,  the  father  of  the  child,  who  had  been  warned  of  the 

'  "  The  Prevention  of  Syphilis,"  Alfred  Fournier,  English  translation,  pp.  43  et  se 


SYPHILIS  57 

danger  of  cohabiting  with  his  wife,  also  became  infected,  and 
subsequently  developed  secondary  symptoms. 

Here  then,  in  resume,  were  six  serious  contaminations  and  one 
death,  all  in  a  single  family,  through  the  infection  introduced  by  a 
nurse. 

I  have  been  accused  of  selecting  the  most  serious  cases  to 
illustrate  the  various  points  of  the  subject  ;  that  in  laying  too 
much  stress  upon  the  dire  effects  I  may  come  to  frighten  the 
public  too  much.  One  cannot,  heaven  knows,  exaggerate  the 
effects  of  this  disease,  but  I  would  not  have  it  thought  that  my 
object  consists  merely  in  making  out  the  case  as  serious  as 
possible. 

My  whole  object  is  directed  towards  setting  forth  actual  facts 
as  clearly  as  possible  and,  at  the  same  time,  towards  emphasizing 
how  fully  adequate  is  the  treatment  which  medical  science  has  at 
its  command  if  only  people  will  learn  to  avail  themselves  of  it. 
That  despite  all  that  I  have  said  about  the  ravages  of  syphilis  the 
disease  is  less  dangerous  than,  say,  typhoid  fever,  if  only  remedies 
are  applied  and  persisted  in  from  the  very  outset.  It  depends 
entirely  upon  the  individual  concerned. 

Thus,  now  that  I  have  given  some  three,  or  four  instances  under 
this  sub-heading  of  grave  results  from  syphilitic  infection,  I  would 
also  allow  some  little  ray  of  light  to  penetrate  through  the  gloom. 
I  find  it  in  some  recent  results  of  salvarsan  treatment  recorded  by 
Colonel  T.  W.  Gibbard,  of  the  Koyal  Army  Medical  College. 

Speaking  in  February,  1914,  Colonel  Gibbard  states  that  of 
sixty-two  consecutive  cases  of  primary  syphilis  occurring  in  the 
past  eighteen  months,  and  kept  under  observation  for  six  to  nine 
months,  not  a  single  one  has  developed  secondary  symptoms.  In 
other  words  the  disease  had  been  absolutely  arrested  in  its 
development  by  efficient  treatment  from  its  early  stages. 

He  further  states  that  salvarsan  treatment  renders  the  patient 
non-infective  in  twenty-four  to  forty-eight  hours. 

I  can  conceive  no  more  potent  argument  than  this  to  induce  a 

patient  to  present  himself  for  treatment  at  the  earliest  possible 

moment. 

Doctors  and  Midwives. 

Owing  to  the  scrupulous  care  which  is  observed  by  medical  men 
and  nurses  in  the  matter  of  disinfection,  both  of  themselves  and 
their  instruments,  cases  of  contamination  are  now  comparatively 


58  THE    PROBLEM   OF   THE    NATIONS 

rare.  But  they  do  occur  and  contagion  may  be,  all  unwittingly, 
passed  on  to  others.  Three  recorded  instances  will  suffice  in 
illustration  :^ 

A  dentist  contracted  a  chancre  of  the  finger  after  operating 
upon  a  patient  with  syphilitic  patches  in  the  mouth. 

A  surgeon,  in  the  course  of  an  operation  upon  a  syphilitic 
patient,  chanced  to  wound  one  of  his  fingers  very  slightly  with  an 
instrument.     Primary  symptoms  developed. 

Another  similar  case^  was  that  of  a  surgeon  with  a  large 
midwifery  practice,  who  pricked  his  finger  with  a  needle  while 
putting  in  some  stitches.  He  knew  his  patient  to  be  infected, 
but  as  no  primary  symptoms  developed  the  surgeon  concluded 
that  he  had  escaped  the  danger.  Some  time  afterwards  pronounced 
secondary  symptoms  appeared. 

Cases  of  infection  by  mid  wives  are  more  common.  Dr.  Duncan 
Bulkley  records  an  epidemic  of  syphilis  in  a  district  in  England, 
where  a  midwife  continued  her  work  although  actively  infected. 
Her  victims  numbered  forty-one.  Of  these  thirty  were  women, 
nine  were  husbands,  and  two  children. 

A  similar  epidemic,  from  similar  causes,  occurred  in  Brive, 
France,  some  forty  years  ago.  There  the  victims  were  more 
than  one  hundred. 

Some  Miscellaneous  Cases  of  Innocent  Contagion. 

Apart  from  the  cases  of  innocent  contagion  in  women  and 
children  it  has  been  estimated  that  extragenital  chancres^  'form 
nearly  10  per  cent,  of  all  chancres.'  They  are  most  commonly 
found  on  the  lips  and  mouth. ^ 

The  poison  may  be  conveyed  to  the  mouth  in  a  variety  of  ways. 
Kissing  is  obviously  a  very  common  medium.  I  have  already 
referred  to  the  small  epidemic  which  occurred  in  Philadelphia 
through  playing  'kiss-in-the-ring'  {ante,  p.  41).  And  there  must 
be  many  hundreds  of  cases  in  which  children  and  women  have 
thus   been   infected.     It   should   be   remarked  that   a  single  kiss, 

'  Recorded  by  Sir  Jonathan  Hutchinson. 

-  I.e.,  primary  symptoms  appearing  in  various  parts  of  the  body,  and  such  as 
are  not  due  to  sexual  intercourse. 

^  Fournier  observed  1,124  cases  of  '  extragenital '  syphilis  and,  of  these,  the 
lips  were  affected  in  567  cases. 


SYPHILIS  59 

even  one  of  respect,  is  quite  sufficient  to  transfer  the  infection. 
Also  that  the  infection  may  be  transferred  in  this  manner  not 
only  to  the  lips,  but  to  the  inside  of  the  mouth,  the  cavity  of  the 
throat  and  tonsils. 

Then  there  is  what  is  known  as  "  mediate  "  contagion,  where 
infection  is  carried  by  drinking  vessels,  feeding  utensils,  paper- 
knives,  penholders,  toys,  speaking  tubes,  &c.  This  may  seem  an 
exaggeration,  but  indeed  there  are  very  many  cases  on  record  of 
such  contagion.     I  will  take  four  at  random  by  way  of  illustration. 

A  little  boy  was  given  a  new  toy  trumpet.  But  none  of  his 
brothers  and  sisters,  nor  his  father  and  mother,  could  blow  it  so 
delightfully  as  an  uncle.  Unfortunately  the  uncle  was  suffering 
from  syphilitic  patches  upon  the  inside  of  the  mouth,  and  so  the 
infection  w^as  spread,  with  fatal  results  for  mother  and  boy. 

A  man  of  60  developed  similar  mucous  patches  on  the  mouth. 
After  prolonged  investigation  it  was  discovered  that  his  valet  had 
been  smoking  one  of  his  master's  pipes.  The  valet  already  suffered 
from  syphilis  and  had  previously  infected  his  fiancee  by  kissing. 

A  medical  student  was  not  careful  enough  to  disinfect  his  hands 
after  his  work.  He  had  the  habit  of  holding  his  pen  between  his 
lips  while  making  notes.  As  a  result  the  poison  was  carried  to 
his  mouth. 

A  well-known  physician  was  in  the  habit  of  sucking  an  ivory 
paper-knife  while  reading.  One  day  he  used  the  knife  as  a  tongue- 
depressor  while  examining  a  girl  with  a  sore  throat  (sic).  He 
forgot  to  clean  the  knife,  and,  as  the  girl  was  really  suffering  from 
syphilis,  he  also  developed  the  disease,  and  with  fatal  results,  for 
he  subsequently  died  of  paralysis  of  the  brain. 

These  four  cases,  out  of  hundreds  which  might  be  quoted,  will 
probably  suffice  to  indicate  not  only  how  terribly  contagious  syphilis 
is,  but  also  in  how  many  cases  the  disease  may  be  acquired 
innocently. 

Under  this  same  heading  I  should  also  mention  a  class  of  cases 
where  syphilis  has  been  contracted  through  industrial  employment. 
The  most  common,  or  at  least  the  best  known,  is  that  of  glass- 
blowing,  and  the  infection  is  spread  by  the  custom  of  handing  the 
glass-blower's  tube  from  mouth  to  mouth. 

Several  epidemics  of  such  infection  are  recorded,  ^  and  I  noticed 

*  "  J)e  la  Syphilis  des  Verriers"  Guinaud,  Paris,  1881. 


60  THE    PROBLEM   OF   THE   NATIONS 

a  case  reported  in  The  Times  about  two  months  ago.  Similarly 
infection  has  been  transferred  by  orchestral  instrumentalists,  by 
electricians  testing  a  current  with  the  tongue;  by  upholsterers 
holding  tacks  in  the  mouth  and  returning  those  not  used  to  a  bag. 
In  fact  it  may  be  spread  through  the  most  unlikely  media ;  in  any 
way  where  there  is  a  possibility  of  mouth  to  mouth  infection,  or 
through  towels,  sponges,  a  barber's  razor  and  so  on. 

Under  this  heading  of  innocent  contagion  we  have  now,  I 
think,  fairly  considered  the  argument  of  those  intensely  moral 
individuals  who  assert  that  sexual  disease  is  adjust  retribution" 
of  immorality. 

We  have  investigated  the  causes  and  effects  of  the  innocent 
contagion  of  women,  and  have  noted  the  average  percentage  of  such 
cases — 20  to  25  per  cent.  We  have  also  seen  some  of  the  dire 
effects  of  syphilis  upon  the  married  state. 

It  will  possibly  be  noticed  that  I  have  made  no  reference  to  the 
converse  side  of  my  argument  regarding  infection  through  marriage, 
viz.,  the  infection  of  an  innocent  husband  by  a  guilty  wife.  For 
one  reason  and  another  such  cases  are  seldom  heard  of.  But  they 
must  occur  and,  probably,  far  more  frequently  than  is  imagined. 
Personally,  I  have  come  across  two  instances ;  one  in  which  the 
wife  had  been  a  professional  prostitute,  and  the  man  married  her, 
naturally  at  his  own  risk;  the  other  was  the  case  of  an  amateur 
prostitute. 

Here  the  girl  had  served  in  a  shop  in  Oxford,  and  being  an 
attractive  young  lady,  secured  for  the  proprietor  no  small  amount 
of  undergraduate  custom.  She  had  probably  two  or  three  lovers, 
and  eventually  married  a  man  in  her  own  rank  of  life,  who  believed 
her  an  innocent  girl.  As  a  matter  of  fact  she  was  at  the  time  of 
her  marriage  in  a  condition  of  active  syphilis.  I  can  record  no 
details  save  that  she  naturally  infected  her  husband,  and  that  her 
first  child  was  born  dead. 

But  when  one  considers  the  amount  of  amateur  prostitution 
in  existence,  and  that  it  is  one  of  the  objects  of  such  a  prostitute  to 
make  herself  out  to  be  an  innocent  woman,  especially  to  the  man 
whom  she  proposes  to  marry,  one  cannot  but  think  that  a  great 
deal  of  tragedy  lies  hidden  from  the  world.  Always  the  wife 
is  presumed  to  be  the  innocent  sufferer. 

To  resume.  I  have  tried  to  indicate  the  appalling  amount  of 
infant  mortality  which  is  due  to  syphilis,  and  also  something  of  the 


SYPHILIS  61 

hideous  effects  upon  children,  the  living  death  to  which  they  are 
so  often  condemned. 

And  lastly  I  have  suggested  how  many  are  the  ways  in  which 
infection  may  be  spread  amongst  the  innocent. 

Is  sexual  disease  still  to  be  accounted  the  "  just  retribution  of 
sin"? 

I  leave  the  answer  to  "  the  liberty  and  faculty  of  every  man's 
judgment." 


62 


VII. 
THE   PEEVALENCE   OF   SYPHILIS. 

I  HAVE  been  trying  to  make  up  my  mind  upon  a  somewhat 
difficult  point  involved  in  the  general  scheme  of  this  work — 
whether  it  is  advisable  or  not  to  give  statistics.  It  is  not  unlike 
the  position  of  Launcelot  Gobbo,  pulled  this  way  and  that  by 
"the  fiend"  and  his  conscience.  Does  the  average  individual  care 
a  rap  about  statistics  ?  And  if  he  does,  will  he  place  any  reliance 
upon  them  ?  They  are,  at  best,  suspicious  things,  admirable 
witnesses  if  they  support  one's  arguments,  to  be  carefully  omitted 
if  they  do  not. 

Carlyle's  "crabbed  satirist"  used  to  remark  that  a  judicious 
man  looks  at  statistics,  not  to  get  knowledge  but  to  save  himself 
from  having  ignorance  foisted  on  him.  And  I  cannot  help  feeling 
that  this  remark  may  be  vigorously  applied  in  the  present  case. 

But  then  there  are  the  critics.  And  I  generally  find  that  the 
critics  are  apt  to  be  far  more  tolerant  towards  statistics,  even 
though  inadequately  compiled,  than  they  are  towards  expressions 
of  opinion,  however  eloquent  and  persuasive.  In  the  present  case 
I  must  say  that  I  agree  with  them. 

On  the  whole,  however,  it  appears  best  in  this  consideration  of 
sexual  disease  to  abide  by  the  vote  of  the  majority.  The  "Noes," 
therefore,  have  it,  and  there  shall  be  as  few  statistical  tables  as 
possible ;  although  I  must  quote  figures  if  I  am  to  indicate  the 
prevalence  of  the  disease.  At  the  same  time,  however,  I  have 
found  in  the  course  of  my  inquiry  that  the  statements  or  estimates 
made  by  specialists  are  most  misleading  unless  the  basis  upon 
which  such  an  estimate  is  founded  is  also  carefully  set  forth.  This 
is  very  rarely  the  case. 

Several  eminent  personages  in  Church  and  State  who  have 
perused  those  statistics  which  have  already  been  given,  and 
others  which  I  proposed  should  follow  in  this  chapter,  have 
remarked  quite  frankly  that  they  did  not  believe  them,  and  have 
advised  me  to  be   as   sparing  with   them   as   possible.     And  if  I 


THE    PREVALENCE    OF   SYPHILIS  63 

have — only  for  tlie  moment  I  hope — been  unable  to  convince 
such  masters  of  learning  of  the  widespread  prevalence,  I  fear 
that  my  chances  of  convincing  the  general  public  are  very  slender 
indeed. 

But  I  would  remark  that  these  figures,  far  from  exaggerating 
the  gravity  of  the  matter,  must  indeed  fall  considerably  short  of 
the  actual  truth.  I  refer  more  particularly  to  those  of  the  civil 
population  in  the  various  countries.  As  regards  those  of  the  Navies 
and  Armies  of  the  world,  I  see  no  reason  to  doubt  their  exactness. 
Nor  indeed  do  I  doubt  the  figures  which  I  have  obtained  from 
Japan.  I  particularly  mention  Japan  because  every  one  who  knows 
the  Far  East  is  most  suspicious  (and  rightly  so,  I  must  confess)  of 
any  official  Government  returns.  But  I  can  conceive  no  line  of 
reasoning  which  would  induce  a  Government  to  assert  that  the 
prevalence  of  sexual  disease  in  its  country  was  greater  than  it 
actually  was.  And  the  state  of  affairs  in  Japan  appears  to  be 
particularly  serious. 

As  I  have  already  several  times  remarked,  the  official  statistics 
of  sexual  disease  are  only  concerned  with  the  three  specific  forms, 
and  take  no  account  of  the  many  other  diseases  which,  we  have 
seen,  are  so  frequently  the  outcome.  And  even  here  we  find  further 
confusion  in  trying  to  arrive  at  an  estimate.  For  it  by  no  means 
necessarily  follows  that  because  the  mortality  from,  say,  aneurysm 
is  on  the  increase,^  therefore  syphilis  is  also  on  the  increase.  Nor 
must  we  deduce  a  corresponding  increase  in  syphilis  from  the 
steady  rise  (in  Great  Britain)  since  1876  of  admissions  into  lunatic 
asylums.^  In  both  cases  we  might  trace  back  the  causes  to  the 
more  improved  methods  in  investigating  the  results  of  syphilis. 

Suppose  we  consider  the  numbers  of  would-be  recruits  annually 
refused  admission  into  the  British  Army  on  account  of  their  being 
infected.  On  the  face  of  it,  this  would  seem  to  offer  a  reasonable 
basis  for  a  broad  calculation  as  to  the  prevalence  of  sexual  disease 
amongst  the  civil  population.  We  should  know,  moreover,  what 
part  of  the  country  each  of  these  men  came  from,  and  this  would 
be  an  additional  help. 

Upon  this  basis  we  should  deduce  that  syphilis  was  decidedly 
upon  the  decrease,  for  the  number  of  refusals  has  been  steadily 
decreasing  since  1873.      For  instance,  106  men  out  of  a  total  of 

^  Vide  supra,  p.  30.  ^  Vide  supra,  p.  29. 


64  THE   PEOBLEM   OF   THE    NATIONS 

61,278  were  refused  on  account  of  syphilis  in  1908,  and  56,  out  of 
47,008,  in  1911-12. 

But  before  accepting  such  a  deduction  there  are  several  facts 
which  must  be  remembered.^  Of  these  the  most  significant  is,  I 
think,  that  candidates  for  enlistment  are  now  generally  well  aware 
that  if  they  go  up  for  medical  examination  with  symptoms  of 
syphilis  they  will  be  rejected.  And  equally  as  important  to  our 
inquiry  is  the  fact  that  candidates  for  enlistment  are  by  no  means 
representative  of  the  civil  population.  Continental  armies  are 
recruited,  under  the  compulsory  service  system,  from  all  classes 
of  the  community,  whereas  the  British  Army  has  to  rely  upon 
volunteers,  and  those  who  volunteer  do  so  from  definite  motives — 
love  of  adventure,  possibly  ;  destitution  or  failure  in  obtaining  other 
employment,  more  frequently.  Would-be  recruits  are  thus  drawn 
from  two  or  three  classes  only  and  we  are  therefore  entitled  to 
draw  our  inferences  as  to  prevalence  of  sexual  disease  only  amongst 
those  particular  classes. 

Some  systematic  and  international  basis  for  the  collection  of 
statistics  in  sexual  disease  is  sadly  needed.  Now  and  again  a  state 
or  city  will  adopt  some  temporary  means  for  collecting  evidence, 
but  it  is  seldom  any  more  than  the  glimmer  from  a  shepherd's 
lantern  across  a  dark  moor.  New  York  City,  for  instance,  has  just 
concluded  a  year's  period  of  compulsory  notification.  Then  we 
have  definite  figures  from  Christiania.  Ten  years  ago  the  Prussian 
Board  of  Education  instituted  a  careful  inquiry  throughout 
Germany.  Most  important  of  all,  perhaps,  we  have  the  results  of 
the  careful  investigation  initiated  by  Dr.  B.  Burnett  Ham  in  the 
State  of  Victoria,  Australia ;  an  investigation  which  has,  I  honestly 
believe,  done  more  than  anything  else  to  arouse  the  public  to  an 
appreciation  of  the  gravity  of  the  situation,  and  to  the  appointment 
of  a  Royal  Commission.  Incidentally,  this  was  the  first  occasion 
in  any  country  when  any  sound  scientific  basis  (the  Wassermann 
reaction)  was  utihzed  to  determine  the  prevalence  of  syphilis  on 
a  large  scale. 

Apart  from  these  and  the  careful  records  of  the  Russian  Health 
Department,  our  material  is  very  meagre.  I  may  assert  that  in 
certain  States  of  South  America  syphilis  is  simply  rampant,  that 
probably  20  per  cent,  of  the  foreigners  (men)  are  infected.     I  might 

'  Some  are  detailed  in  Dr.  Johnstone's  Report  to  the  Local  Government 
Board,  1913. 


THE    PEEVALENCE   OF   SYPHILIS  65 

quote  evidence  to  show  that  the  Esquimaux  suffer  from  the  disease 
in  a  particularly  virulent  form  ;  that  it  is  very  prevalent  along  the 
littoral  of  Northern  Africa  ;  that  it  runs  like  a  plague  through  the 
native  races  of  South  Africa  ;^  that  its  grisly  fingers  have  stretched 
spectre-like  through  the  teeming  millions  of  China  ;  that  Islam 
knows  its  horrors  no  less  than  Protestantism ;  that  wherever  our 
so-called  civilization  has  penetrated  there  will  syphilis  already  be 
found  sapping  the  manhood  and  womanhood  of  the  country.  Are 
all  these  but  travellers'  tales  ? 

But,  after  all,  this  consideration  of  the  prevalence  of  syphilis 
is  no  more  than  a  digression.  The  '  man-in-the-street '  is  not 
particularly  concerned  with  it.  It  may  possibly  form  matter  of 
additional  interest  in  the  same  way  as  the  succeeding  articles  on 
international  aspects,  prostitution,  and  other  side  issues,  but  that 
is  all. 

I  will,  however,  for  the  sake  of  completeness,  attempt  some  kind 
of  estimate  from  such  selected  data  as  we  have  available.  Let  us 
take  first  the  results  of  the  investigation  in  Melbourne.^ 

For  twelve  months  syphilis  was  made  compulsorily  notifiable, 
but  it  is  known  that  a  certain  number  of  private  practitioners  did 
not  report  any  cases.  Of  5,700  cases  reported,  3,160  were  found  to 
be  syphilitic,  or  0'5  per  cent,  of  the  population.  Five  hundred 
and  fifty  cases  at  the  Victoria  Eye  and  Ear  Hospital  w^ere  also 
examined.     Of  these  13*3  per  cent.,  or  1  in  8,  were  syphilitic. 

As  a  result  of  these  and  other  investigations  upon  similar  lines 
it  was  concluded  that  approximately  5  per  1,000  of  the  Melbourne 
population  were  infected  with  syphilis  ;  that  the  damage  caused  by 
this  and  gonorrhoea  must  be  enormous. 

These  results  are  particularly  instructive  because  Australia  is, 
practically  speaking,  a  new  country,  and  one  in  which  syphilis 
would  scarcely  be  expected  to  have  obtained  so  firm  a  foothold. 
The  important  fact  should  also  be  noted  that  while  prostitution 
does  flourish  in  the  cities  of  Australia  there  is  no  economic  necessity 
for  women  there  to  earn  their  living  in  such  a  manner. 

'  The  Lancet  of  March  28,  1914,  records  particulars  of  the  rapid  spread  of 
syphilis  in  South  Africa,  especially  amongst  the  Zulus,  one  of  the  finest  of  native 
races.  In  the  same  Journal  (May  11,  1912)  will  be  found  a  suggestive  paper  by 
Mr.  B.  G.  Brock  upon  "  The  Prevalence  of  Syphilis  amongst  the  Natives  of  South 
Africa." 

'  A  detailed  account  of  this  investigation  will  be  found  in  Proceedings  of  the 
Boyal  Society  of  Medicine,  vol.  v,  No.  9  (Supplement),  p.  174  et  seq. ;    also  in 
Bedrock,  April,  1913. 
5 


66 


THE   PEOBLEM   OF   THE   NATIONS 


With  centuries  of  crowded  life  behind  us  have  we  any  reason- 
able grounds  for  presuming  that  Great  Britain  is  in  a  better 
position  than  South  Australia  ? 

Think  for  a  moment  of  the  conditions  which  obtain  in  our  great 
cities,  industrial  centres,  and  seaports — the  overcrowded  homes 
of  the  poorer  classes,^  the  impossibility  of  decent  privacy  in  their 
daily  lives,  the  constant  intermingling  of  the  sexes,  the  absence 
of  sanitation,  the  use  and  abuse  of  alcoholic  liquor — all  powerful 
factors  in  the  spread  of  sexual  disease. 

Think  of  the  vast  amount  of  uncontrolled  professional  prostitu- 
tion, and  the  increase  in  amateur  prostitution.  Think  of  the  hope- 
less inadequacy  of  our  existing  facilities  for  treatment  of  patients. 
Paris,  with  a  population  of  2|  millions,  has  2,000  beds  available  for 
such  cases ;  Berlin,  with  over  2  million  inhabitants,  has  a  still 
larger  number  ;  London,  with  a  population  of  4^  millions,  can 
muster  no  more  than  200. 

Prevalence  iti  Japan. 

The  figures  given  on  page  12  to  indicate  the  prevalence  of 
gonorrhoea  over  syphilis  in  Japan  afford  also  valuable  evidence 
of  the  incidence  of  syphilis  amongst  the  civil  population  in  that 
country  ;  4*75  per  1,000  of  the  young  men  of  20  years  old  are 
infected.  And  if  chancroid  and  gonorrhoea  are  also  taken  into 
account  we  get  the  extraordinary  figure  of  25*26  per  1,000  males 
at  this  age  suffering  from  sexual  disease. 

As  regards  the  mortality  from  syphilis  in  Japan  the  returns  of 
the  Imperial  Statistical  Bureau  of  the  Cabinet  show  that,  since  1907, 
the  figure  stands  at  0'2  per  1,000  of  the  population,  and  9  per  1,000 
deaths.  The  general  mortality  has  been  20  per  1,000  of  the 
population. 

Here  are  the  figures  in  tabular  form  : — 

Japan. 
Mortality  from  Syphilis. 


Sex 

Per  1,000  population 

Per  1,000  deaths 

1907 

190S 

1909 

1907 

1908 

1909 

Male 
Female    . . 

0-20 
0-17 

0-21 
0-18 

0-22 
0-19 

9-8 
8-1 

10-0 

8-5 

10-1 
8-5 

Total 

0-19 

0-19 

0-20 

8-9 

9-3 

9-3 

Especially  in  Dublin,  where  syphilis  is  particularly  prevalent. 


THE    PREVALENCE    OF    SYPHILIS 


67 


The  Japanese  Army. 
As  already  indicated,  professional  prostitution  in  Japan  is  regu- 
lated like  a  definite  State  Department.     In  the  Ai'my  aud  Navy 
any  intercourse  with  an  unlicensed  prostitute  is  strictly  prohibited, 
and  in  certain  of  the  Army  divisions  imprisonment  is  inflicted  upon 


23Cr 


220 


2IQ 


;oo 


190 


180 


170 


£0 


26 

24 
22 
20 
18 
16 
14 


1897  i  1896 

1899 

1900 

1901 

1902 

1903  1904 

1905 

1906   1907  IS08   1SC9 

1910 

1911 

1 

A 

. 

■ 

1 

1   ^ 

y 

/ 

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1 
1 

/ 

\ 

A 

1      1 
1 

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\       1 

M 

j 

A  ! 

\ 

\ 

/ 

\ 

Y 

f 

/ 

^ 

/ 

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\l 

f 

\ 

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1  \ 

,\ 

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t  \ 

\ 

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"^ 

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V' 

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t 
^-^ 

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1 

\^ 

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1 

1 

\/ 

^^. 

V' 

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14Q 

130 

120 

110 

100. 

90 

80 

70 


The  upper  black  line  denotes  the  number  of  new  cases  of  sexual  disease  per  1,000 
average  daily  number  of  sailors.  The  lower  dotted  line,  with  the  figures  to  the  left, 
denotes  the  number  of  new  sexual  disease  cases  against  the  total  number  of  new  cases 
of  sickness  of  all  kinds,  including  sexual  disease. 


a  soldier  who  is  proved  to  have  so  acted.  Apart  from  the  various 
preventive  measures  in  force  a  soldier  who  has  contracted  any 
form  of  sexual  disease  is  penalized  by  confinement  to  barracks  and 
stoppage  of  part  of  his  pay. 


68  THE    PROBLEM    OF   THE    NATIONS 

Prevalence  of  Disease. — As  in  our  own  Army,  the  incidence  of 
sexual  disease  is  found  to  be  diminishing,  though  by  no  means  to 
the  same  extent.  The  average  of  cases  during  the  period  1896-1905 
was  64'2  per  1,000  soldiers,  but  in  1902  the  figure  was  only  36"1. 
In  1905  the  average  again  rose  to  43'0  per  1,000.  The  present 
average  is  approximately  47"5  per  1,000,  or  of  syphilis  alone  9"5 
per  1,000. 

The  Japanese  Navy. 

Preventive  measures  in  the  Japanese  Navy  include  a  monthly 
medical  examination  of  all  men  below  the  rank  of  warrant  officer, 
when  any  case  of  infectious  sexual  disease  is  confined  to  his  ship 
for  treatment  and  for  the  week  following  the  establishment  of  cure. 
Lectures  upon  the  subject  are  given  at  regular  intervals,  and  all 
possible  methods  are  adopted  to  check  the  disease.  Apparently, 
however,  the  results  have  not  proved  so  satisfactory  as  in  the  Army. 

Professor  Dr.  S.  Hata  has  very  kindly  prepared  for  me  a  diagram 
to  illustrate  the  prevalence  of  sexual  disease  in  the  Navy,  per  1,000 
sailors,  and  this  I  append  (see  page  67). 

Elsewhere  I  propose  to  speak  of  the  regulation  of  prostitu- 
tion in  Japan,  and  of  the  laws  in  force  for  the  prevention  of 
sexual  disease.  I  am  giving  a  more  detailed  consideration  to  causes 
and  effects  in  this  country,  partly  because  the  facts  are  compara- 
tively unknown,  even  amongst  eminent  specialists  in  Europe  ;  and 
also  because  I  cannot  but  think  that  Japan,  in  this  respect,  affords 
the  most  valuable  object-lesson  of  all  the  countries  in  the  world. 

New  YorJi  City. — On  January  1,  1913,  the  Board  of  Health  of 
this  city  initiated  a  system  of  compulsory  notification  of  all  cases 
of  sexual  disease,  both  those  receiving  treatment  in  institutions  and 
also  at  the  hands  of  private  physicians.  Naturally  a  considerable 
number  of  these  latter  cases  have  not  been  reported,  but  at  least  we 
now  have  some  kind  of  a  record  for  one  year. 

10,625  cases  of  syphilis  alone  have  been  reported.  As  the 
population  of  New  York  is,  in  round  figures,  4|  millions,  we  get  a 
figure  of  2-2  per  1,000. 

But,  as  Dr.  Goldwin  tells  me,  this  figure  represents  a  small 
fraction  only  of  the  total  incidence  during  that  year.  For  instance, 
in  a  New  York  State  Eeformatory  for  women  the  Wassermann 
test  was  applied  to  466  inmates,  with  the  result  that  48  per  cent. 


THE    PREVALENCE    OP    SYPHILIS 


69 


gave  "  positive "  reactions.  And  the  results  of  other  similar 
investigations  suggest  a  heavy  incidence. 

Again,  we  have  the  estimate  given  by  Dr.  A.  Prince  Morrow  to 
the  effect  that  there  are  over  200,000  infected  persons  at  large  in 
New  York ;  but  this  figure  includes  gonorrhoea  as  well  as  syphilis. 
The  percentage  of  sexual  disease  cases  in  the  United  States  Navy 
is  also  very  high. 

Siberia. — The  number  of  cases  of  syphilis  officially  reported 
from  Siberia  for  the  year  1911  was  57,360.  The  population  is 
given  as  9|-  millions.  An  average  of  6  per  1,000.  The  percentage 
for  Russian  Central  Asia  is  rather  less  than  this. 

Russia  in  Europe. — The  official  returns  published  by  the  Health 
Department  of  St.  Petersburg  are  extraordinarily  complete.  They 
give  not  merely  the  number  of  cases  reported  of  sexual  disease  in 
its  three  varieties,  but  they  record  the  number  of  cases  of  primary, 
secondary,  and  tertiary  syphilis  respectively  in  every  province 
throughout  the  whole  Empire,  and  also  the  number  of  these  cases 
attended  by  fully  qualified  medical  men  and  by  irregularly  qualified 
students  ^  respectively.  I  will  take  some  four  or  five  localities 
and  give  the  figures  of  cases  of  syphilis  per  1,000  of  the  population 
as  I  have  calculated  them  from  the  official  records  : — 


Moscow  Industrial  Begion 

Central  Agricultural  Region 

Lithuania    . . 

Little  Russia 

City  of  St.  Petersburg 

City  of  Moscow 


10     per  1,000 
16 

1-3 

5-1 

27 
22 


These  figures  are  of  particular  interest  for  purposes  of  com- 
parison. Thus  we  find  in  an  agricultural  region  a  higher  per- 
centage than  in  an  industrial  one,  and  the  exact  converse  of  this 
is  generally  the  rule. 

Little  Russia  is  perhaps  the  richest  and  most  populous  province 
of  the  Empire;  Lithuania  is  probably  the  poorest,  and  the  condition 
of  the  peasantry  is  deplorable.  And  yet  in  this  province  there 
were,  in  1911,  over  7,300  cases  of  syphihs  in  a  population  of 
5-|  millions. 

The  reason  for  these  high  percentages  in  the  country  districts 
lies  in  the  fact,  to  which  I  have  already  referred,  that  in  many  of 

^  We  have  no  exact  equivalent  in  this  country.     Perhaps  th3  old  "  barber 
surgeon''  is  the  nearest. 


70 


THE   PROBLEM   OF   THE   NATIONS 


the  villages  syphilis  is  endemic.  It  is  there  a  plague  which  spares 
none,  men,  women  nor  children.  According  to  Tarnowsky  70  per 
cent,  of  the  cases  are  due  to  "  innocent "  contagion.  In  Tambov 
and  Saratov,  two  towns  in  South-east  Bussia,  the  percentage  of 
cases  is  second  only  to  St.  Petersburg. 

A  further  point  of  interest  is  that  in  Little  Russia  there  were 
far  more  cases  of  tertiary  syphilis  than  secondary;  while  in 
Lithuania  there  were  three  times  as  many  secondary  cases  as 
tertiary. 

Having  the  official  records  before  me  it  may  possibly  be  ot 
interest  if  I  give  the  figures  for  the  whole  of  the  Russian  Empire. 
In  19ll  there  were  recorded  rather  fewer  than  1,265,000  cases  of 
syphilis,  in  all  its  forms.  The  population  of  the  Empire  is  given 
as  167,520,000.  Thus  there  were  infected  75  per  10,000  of  the 
population  of  a  territory  representing  one-sixth  of  the  land  surface 
of  the  globe. 

Boumania. — Statistics  upon  the  incidence  of  syphilis  in 
Roumania  are  somewhat  incomplete  and  are  not  recorded  with 
care.  All  infectious  disease  is  subject  to  compulsory  notification 
with  the  exception  of  sexual  disease  and  measles. 

Amongst  the  civil  population  throughout  the  country  in  1909  the 
average  number  of  syphilitics  was  found  to  be  2 "35  per  1,000.  Taking 
Bucharest  alone  the  figure  of  sexual  disease  is  given  as  5*2  per  1,000. 

As  in  Russia,  we  find  a  distinct  difference  in  the  prevalence  of 
syphilis  according  to  the  locality.  In  the  mountainous  district  of 
Roman,  for  instance,  the  average  is  as  high  as  15  per  1,000,  while 
in  Romanatzi  it  is  only  O'l  per  1,000. 

In  the  Roumanian  Army  the  official  returns  give  an  average  of 
50  men  per  1,000  suffering  from  sexual  disease. 

Norway. — Perhaps  the  most  reliable  figures  upon  the  prevalence 
of  sexual  disease  are  those  recorded  in  Christiania,  where  the  diseases 
have  been  notifiable  in  one  form  or  another  since  1876.  I  append 
the  figures  for  the  years  1906 — 1911  : — 

Population  I       Gonorrhcea         ^Hf^^^l^^:,^    syptu^per ?000 

of  the  population 


1906 
1907 
1908 
1909 
1910 
1911 


229,324: 
231,687 
235,674 
239,511 
244,038 
247,488 


1,240 
1,015 
1,162 
1,250 
1,359 
1,467 


2-1 
1-8 
20 
2-2 
2-1 
2-2 


THE    PREVALENCE    OF    SYPHILIS  71 

It  may  be  added  that  since  1887  all  cases  of  sexual  disease  have 
been  notifiable  daily  instead  of  monthly  and  thus  still  greater 
accuracy  has  been  ensured. 

Copenhagen. — I  take  this  city  immediately  after  Christiania  for 
a  comparison  between  the  figures  of  the  two  capitals  is  of  interest, 
because  the  system  of  notification  in  Copenhagen  is  very  inadequate 
compared  with  that  of  Christiania,  and  yet  the  figures  are  very  much 
higher.  Probably  this  is  owing  in  great  measure  to  the  fact  that 
a  case  may  be  notified  more  than  once.  About  2,000  neiv  cases  of 
syphilis  are  annually  notified  in  Copenhagen,  3'5  per  1,000  of  the 
total  population.  From  this  figure,  and  taking  the  average  age  of 
incidence  as  25  j'-ears.  Professor  Erik  Pontoppidan  calculates  that 
"  50,000  individuals  out  of  a  population  of  400,000,  at  any  fixed 
period,  have  or  have  had  syphilis."  This  means  12"5  per  ceiit.  of 
the  population. 

I  will  merely  quote  the  official  average  of  syphilis  : — 

1906 3-3  per  1,000    1909 4*9  per  1,000 

1907 4-5   „       1910 5-3 

1908 5-6   ,,       1911 5-8   ,, 

Germany. — There  is  such  a  mass  of  literature  by  German  authors 
upon  this  subject  that  it  is  very  difficult  to  sift  the  evidence. 
Perhaps  the  most  trustworthy  figures  are  those  published  in  the 
report  to  which  I  have  referred  on  page  13.  But  even  these  are 
not  particularlj^  satisfying,  and  it  is  possible  only  to  make  an 
approximate  calculation. 

On  April  30,  1900,  according  to  the  official  returns,  there  were 
14'2  per  1,000  adult  men  in  Berlin  under  treatment  for  sexual 
disease.  The  prevalence  amongst  the  female  population  was  rather 
less  than  half  that  of  the  male.  The  population  of  Berlin  ten  years 
ago  may  be  given  as  2  millions.  Of  the  figure  14" 2  per  1,000  it 
is  estimated  that  four-fifths  are  recent  cases,  or  11*4  recent  cases  of 
sexual  disease  per  1,000  men. 

Now  let  us  add  in  the  women,  taking  the  incidence  as  j^ths  that 
of  the  men.  Also  let  us  add  in  the  odd  fifth  to  give  us  the  total 
number  of  cases,  recent  and  standing.  This  calculation  gives  us 
about  106,000  cases  of  sexual  disease  as  a  whole,  recent  and  standing, 
amongst  the  Berlin  population — 53  per  1,000  ! 

From  the  official  figures  I  calculate  that  cases  of  syphilis 
represent  approximately  one-third  of  the  total  number  of  cases  of 


72  THE   PROBLEM   OF   THE   NATIONS 

sexual  disease.^  We  therefore  get  the  figure  3"8  recent  cases  of 
syphilis  per  1,000  men. 

Add  the  female  incidence  to  this  and  the  figure  is  5*4  per  1,000 
men  and  women  recently  infected  with  syphilis  alone. 

Following  this  system  of  calculation  we  find  the  incidence  of 
syphilis,  recent  and  standing  cases,  is  35,416  men  and  women.  And 
thus  the  average  of  syphilis  in  Berlin  is  17'5  (say  18)  per  1,000  of 
the  total  population. 

As  a  side-light  upon  this  issue  I  may  quote  a  passage  from 
Professor  Blaschko's  work,  "  Hygie^ie  der  Prostitution."  There  he 
estimates  that  45  per  cent,  of  the  clerk  and  merchant  class  in  Berlin, 
between  the  ages  of  18  and  28,  have  had  syphilis,  and  120  per  cent, 
have  contracted  gonorrhoea.  In  Breslau  the  figures  are  77  per 
cent,  for  syphilis,  and  200  per  cent,  gonorrhoea.  He  adds,  further, 
that  every  university  student,  during  his  four  years'  course,  contracts 
one  form  or  other  of  sexual  disease  at  least  once.^ 

Another  eminent  authority  estimates  that  one  German  in  five 
has  had  syphilis,  and  that  the  average  for  gonorrhoea  is  more  than 
one  attack  per  man.^ 

Of  course  the  condition  of  affairs  amongst  the  male  population 
which  these  statements  imply  is  simply  appalling.  It  is  partly 
because  the  number  of  women  in  the  total  population  is  so  much 
in  excess  over  the  men  that  the  percentage  of  disease  is  brought 
down  to  a  credible  limit. 

There  are  many  other  estimates  and  figures  which  I  migTit 
quote,  particularly  in  respect  to  prevalence  in  the  army  and  navy. 
But  this  work  is  written  for  the  general  public  and  it  has  no 
pretensions  to  be  regarded  as  a  scientific  treatise,  for  relegation  to 
the  shelves  of  a  medical  library. 

There  is,  however,  one  more  point  in  the  German  statistics  to 
which  I  may  invite  attention.  It  is  found  that  the  incidence  of 
sexual  disease  is  almost  always  proportionate  to  the  size  of  the 
town.  Thus,  taking  the  adult  males  alone,  we  find  the  following 
proportions  : — 

'  Cf.  the  table,  Incidence  in  Berlin  Sick  Clubs,  on  page  13  ante. 

'  And  yet  the  official  inquiry  returns  give  the  figure  for  sexual  disease  as  a 
whole  as  only  14"2  per  1,000  males  in  Berlin.  How  is  it  possible  to  reconcile  this 
figure  with  an  authoritative  estimate  that  120  men  per  1,000  are  infected  with 
syphilis  alone  ?     What  is  one  to  believe  ?     How  hopeless  all  this  investigation  is  ! 

^  "  Verhutv/ng  der  Geschlechtshrankheiten." — Pinkus. 


THE    PREVALENCE    OF    SYPHILIS 


73 


Berlin,  with  2,000,000  inhabitants    . . 
Cities  with  more  than  100,000  inhabitants 
„        30,000 


14-2  per  1,000  males 
10-0    ,, 
5-8    „ 

4-5    ,,        „        „ 


In  other  words  it  is  found  that  the  number  of  prostitutes, 
professional  and  amateur,  and  so  the  incidence  of  disease,  increases 
with  the  size  of  the  town.  Presumably  it  is  a  question  of  demand 
and  supply. 

This  fact  naturally  suggests  another  factor,  that  of  the  regula- 
tion of  prostitution,  upon  which  I  shall  have  something  to  say  in 
another  article.  But  I  may  remark  here  that  between  the  years 
1903-5  the  percentage  of  sexual  disease  infection  amongst  recruits 
for  the  German  Army  was  highest  in  those  cities  where  regulation 
of  prostitution  is  most  effective.  Also  that  the  incidence  of  disease 
amongst  the  recruits  decreased  proportionately  with  the  size  of 
the  town. 

I  have  now,  I  think,  given  a  suihcient  general  indication  of 
the  prevalence  of  syphilis  through  the  world.  I  have  purposely 
avoided  a  detailed  account,  and  I  have  refrained  also,  so  far  as 
possible,  from  accepting  the  estimates  of  specialists  save  only 
where  they  expressly  state  the  basis  of  their  calculations.  The 
figures  given  are  without  exception  extracted  from  official  com- 
munications, and  it  was  not  until  I  had  concluded,  quite  in- 
dependently, my  own  calculations  that  I  turned  to  estimates 
already  published  for  the  sake  of  comparison.  I  then  discovered 
the  series  of  inaccuracies  to  which  I  refer  later. 

For  the  sake  of  convenience  we  may  now  consider  our  seventeen 
results  in  tabular  form  : — 


INCIDENCE  OP  SYPHILIS  IN  VARIOUS  LOCALITIES. 


Bemarks 


Period 

Locality 

Per  1,000  of 
the  population 

1911     . 

.     City  of  St.  Petersburg  . . 

*27 

1911     . 

, ,       Moscow   . . 

..   *22       .. 

1900     . 

,,       Berlin 

..    "18       .. 

1911     . 

.     Central     Agricultural     Reg 

ion, 

Russia 

..   *16       .. 

1909     . 

.     Roman  (Roumania) 

. .     15       . . 

1911     . 

.     Moscow  Industrial  Region 

..   *10       .. 

1911     . 

.      Siberia 

..   *  6       .. 

1911     . 

.     City  of  Copenhagen 

..       5-8    .. 

Notification  not  very  exact. 


Fairly  represents,  I  think,  the  number  of  recent  and  standing  cases. 


74 


THE    PEOBLBM   OF   THE    NATIONS 


_    .   ,  T       i-t  Per  1,000  of 

Penod  Locality  ^j^^  population 

1909     ..  Bucarest 5-2    .. 

1911     ..  Little  Russia        *5-l    .. 

1910-11  Melbourne  *5       .. 

1909-12  Japan        5 


1909 
1913 


Eoumania 
New  York  City 


1906-11  City  of  Christiania 
1911  . .  Lithuania  (Russia) 
1909     . .     Romanatzi  (Roumania) 


2-3 
2-2 


►2-0 


'■1-3 


0-1 


Remarks 

One  of  the  richest  provinces 

in  the  Empire. 
Underestimated,    and    vide 

p.  65  ante. 
Very  approximate  only.   The 

incidence    of    syphilis   is 

about  i  the  total  amount 

of  sexual  disease. 

One  year's  compulsory  noti- 
fication :  much  under- 
estimated. 

Average  for  five  years.  Noti- 
fication reliable. 

One  of  the  poorest  provinces 
in  the  Empire, 


*  Fairly  represents,  I  think,  the  number  of  recent  and  standing  cases. 


I  must  once  again  emphasize  the  fact  that  these  returns  are 
approximate  only  and  can  only  be  accepted  as  affording  a  general 
indication  of  the  incidence  of  syphilis.  No  account  whatever,  save 
to  some  degree  in  the  Melbourne  figure,  is  taken  of  the  results  of 
syphilis,  and  we  have  already  seen  the  nature  and  extent  of  some 
of  those  results. 

I  hope  that  my  methods  of  calculating  these  figures  are  quite 
clear.  The  chief  difi&culty  lies  in  distinguishing  between  an  annual 
incidence  {i.e.,  number  of  fresh  cases  notified  in  a  year)  and  those 
which  I  have  termed  "  standing "  cases.  For  instance,  under 
Copenhagen  I  have  given  a  specialist's  calculation  of  the  amount 
of  the  syphilised  population  to  be  125  per  1,000.  While  it  is 
naturally  invidious  upon  my  part  to  criticize  such  an  authority 
he  seems  to  me  to  have  presumed  that  none  of  his  cases  have 
been  cured. 

But,  unless  otherwise  indicated,  I  have  taken  figures  supplied 
to  me  by  the  various  statistical  bureaux  and  then  worked  in  simple 
proportion.  As  regards  Bussia,  I  felt  justified  in  adding  together 
the  number  of  cases  of  primary,  secondary,  and  tertiary  syphilis, 
and  stating  the  result  to  represent  "  recent"  and  "  standing"  cases. 
For  the  rest,  I  think  I  have,  in  every  case,  stated  how  I  arrived 
at  my  results,  and  these  results,  in  the  tabular  form,  are  certainly 
fairly  uniform. 

I  am  sorry  to  be  compelled  to  inflict  these  explanations  upon 


THE    PREVALENCE    OF    SYPHILIS  75 

the  reader,  but  he  will  probably  have  no  idea  of  the  great  difficulties 
involved  and  how  open  to  criticism  any  sexual  disease  figures  are. 

England  and  Wales. 

Now  it  will  be  asked,  "  What  of  England  and  Wales  ?  How  do 
we  stand?"  I  must  needs  reply  that  I  can  find  no  evidence  of  any 
real  value  upon  which  to  base  '^ven  a  very  broad  estimate.  The 
attempt  has  been  made  upon  several  occasions,  but  it  has  resolved 
itself  for  the  most  part  into  mere  guess-work. 

For  reasons  already  given  I  regard  the  Army  recruiting  figures 
as  valueless  for  our  purpose.  Returns  from  the  hospitals  are, 
with  one  exception,  non-existent,  or  at  least  untrustworthy.^  The 
Eegistrar-General's  mortality  statistics  are  equally  useless  when  it 
comes  to  the  question  of  prevalence.  There  is  no  system  of 
notification  of  sexual  disease ;  nor  has  any  definite  official  inquiry 
ever  been  made  upon  the  lines  adopted  in  Germany  in  1900,  in 
Melbourne  three  years  ago,  or  in  New  York  last  year.^ 

The  only  fact  of  any  real  value  which  can  be  adduced  is  that 
the  incidence  of  sexual  disease  in  the  British  Navy  and  Army 
has  been  steadily  decreasing  during  the  past  twelve  years  or  so. 

Even  this  knowledge  is  of  little  or  no  use  to  our  inquiry.  It  is 
good  to  be  able  to  record  it  because  it  shows  how  effectively  the 
disease  may  be  combated  by  measures  of  education  and  improved 
treatment.  And,  as  a  result,  we  know  that  our  sailors  and  soldiers 
are  proportionately  a  finer  body  of  men.  But  I  fail  to  see  that 
we  can  trace  the  least  connection  between  this  and  the  incidence 
of  disease  in  the  civil  population. 

There  appears  to  be  a  general  consensus  of  opinion  amongst 
British  speciahsts  that  syphilis,  in  its  ordinary  symptoms,  is  far  less 
in  evidence  than  it  was  forty  years  ago,  but,  on  the  other  hand, 
that  the  cases  of  grave  disorders  and  diseases  derived  from 
syphilis  are  on  the  increase.  Of  this  fact  I  have  already  quoted 
evidence. 

Now  before  I  go  any  further  into  this  question  of  prevalence 
of  syphilis  in  Great  Britain,  I  would  make  brief  criticism  of  one 
or  two  estimates  on  the  subject  which  have  already  been  published. 
I  do  so,  not  for  the  sake  of  criticizing,  but  rather  to  indicate  how 

'  Dr.  Johnstone's  Report  to  the  Local  Government  Board,  1913,  p.  9. 
'^  A  Committee  was  appointed  by  the  British  Admiralty  in  1864  to  determine 
ways  and  means  of  checking  sexual  disease  in  the  Navy  and  Army. 


76  THE    PROBLEM   OF    THE    NATIONS 

very  easily  mistakes  may  be  made  in  this  most  difficult  subject, 
and  how  misleading  an  impression  may  thereby  result.^ 

I  have  already  suggested  that  my  object  in  writing  these 
articles  is  primarily  to  give  to  the  public  only  an  account  of  the 
causes,  symptoms  and  effects  of  sexual  disease ;  that  the  question 
of  prevalence  is  but  incidental.  The  prevalence  of  syphilis 
throughout  the  world  is  certainly  very  wide,  but  I  would  strongly 
deprecate  any  attempt  at  exaggeration. 

Now  in  a  report  recently  issued,  and  one  which  is  being 
very  extensively  quoted,  I  find  that  the  author  has  mis-read  a 
certain  estimate  of  a  distinguished  Continental  specialist.  Upon 
this  mis-reading  he  has  made  a  calculation  for  London  which 
produces  an  enormous  figure.  In  other  words  the  specialist  has 
given  an  estimate  of  so  many  per  cent,  of  the  male  population, 
and  the  author  has  read  it  as  referring  to  the  total  population. 
A  vastly  different  thing. 

Again,  another  medical  man,  in  the  course  of  an  address  at 
a  recent  Health  Congress,  stated  that  7  per  cent.  (70  per  1,000) 
of  the  Melbourne  population  was  syphilitic,  and  upon  this  basis 
calculated  that  in  Greater  London  {sic)  there  were  over  500,000 
cases.  But  the  percentage  of  infection  in  Melbourne  is  not  7,  but 
0*7,  or,  to  be  more  exact,  0'5  (5  per  1,000).  The  other  figure  is 
preposterous,  and  exists  nowhere  in  the  world.  Upon  this  real 
percentage  basis  the  cases  in  the  county  of  London  would  number 
50,750.  Unfortunately  this  author  did  not  sto|)  there  but  went 
on  with  further  misquotations.  He  stated  that  the  percentage  of 
syphilis  for  the  great  capitals  was  "  commonly  estimated  at  about 
20."  But  if  50  per  1,000  is  impossible,  what  shall  v/e  say  of  200 
per  1,000  ?  He  then  added  in  gonorrhoea  and  chancre  and  brought 
the  incidence  to  five  times  as  large  a  figure.  From  that  point  the 
author  became  involved  in  such  a  maze  that  I  gave  up  all  idea  of 
further  checking. 

I  have  recently  been  dipping  into  a  book  dealing  incidentally 

'  In  a  letter  to  the  Lancet  (A.pril  4,  1914),  I  invited  the  attention  of  the 
medical  profession  to  some  of  these  inaccuracies.  The  Editor,  supporting  this 
letter  in  a  leading  article,  wrote  seriously  of  the  dangers  arising  from  inaccurate 
and  carelessly  estimated  figures.  "  If  an  evil,  admittedly  very  large,  is  mag- 
nified, "  he  concluded,  "  many  people  will  consider  that  nothing  can  be  done  in 
the  face  of  such  appalling  mischief."  It  is  significant  that  none  of  the  medical 
men,  whose  statements  I  had  criticized,  replied  to  the  letter  or  article.  Pre- 
sumably, there  was  no  answer  to  be  made. 


THE    PREVALENCE    OF    SYPHILIS  77 

with  this  subject  and  issued  from  an  authoritative  source.  The 
author  gives  certain  statistical  tables  of  prevalence  of  sexual 
disease,  but  it  is  impossible  to  tell  whether  his  figures  mean 
so  many  per  cent.,  per  1,000  or  per  10,000.  The  percentage  basis 
seems  correct  in  one  figure  but  impossible  in  the  next. 

In  fact  it  is  just  over  this  percentage  basis  that  these  various 
authors  have  come  to  grief.  And  the  mistakes  are  so  obvious  that 
I  cannot  imagine  how  they  were  ever  made.  In  nearly  everv  case 
the  author  has  omitted  to  follow  the  excellent  piece  of  advice 
quoted  by  Lord  Kosebery,  "Always  wind  up  your  watch  and 
verify  your  quotations,"  and  the  results  are  deplorable. 

And  the  unfortunate  thing  is  that  these  statements  are  coming 
to  be  quoted  more  and  more.  Other  authors  will  calculate  upon 
them,  lecturers  will  glibly  reel  them  off,  the  Press  will  repeat 
them,  the  '  man-in-the-street '  will  discuss  them,  until  at  last  some 
insignificant  individual  will  prick  the  bubble  and  discredit  will 
fall  upon  the  medical  profession.  Not  that  I  pretend  to  any 
mathematical  accuracy,  for  with  these  sexual  disease  figures  it  is 
like  trying  to  thread  needles  in  the  dark.  Bat  at  least  it  is 
independent  working  and  the  whole  subject  has  been  approached 
with  an  open  mind. 

But  to  resume.  How  can  we  arrive  at  any  estimate  of  pre- 
valence in  Great  Britain  ?  Speaking  quite  frankly  I  know  of  no 
means.  I  shall  doubtless  be  accused  of  shirking,  but  it  cannot 
be  helped.  We  have  literally  no  data  of  any  value.  I  have  tried 
half  a  dozen  methods,  only  to  discard  the  results  as  useless.  So 
far  as  I  can  see  the  only  two  facts  which  are  capable  of  any  use 
are  (a)  the  figures  for  Melbourne  and  Christiania,  and  (b)  that  the 
incidence  of  disease  tends  to  increase  with  the  size  of  the  town. 

But  even  this  system  of  arithmetical  progression  will  not  serve. 
It  may  give  an  approximately  reliable  figure  for  a  series  of  towns 
of  one  nation,  but  when  we  apply  it  to  a  number  of  nations,  various 
other  factors,  such  as  racial  characteristics  and  temperaments,  must 
be  taken  into  account.  I  do  not  trace  any  connection  between 
climatic  conditions  and  sexual  disease.  Perhaps  the  incidence  in 
certain  parts  of  South  America  is  more  heavy  than  anywhere  else 
in  the  world,  but,  on  the  other  hand,  St.  Petersburg  and  Moscow 
are  in  almost  as  serious  a  plight. 

I  can  best  show  the  results  of  the  "  progression"  basis,  starting 
with  Melbourne,  by  setting  down  side  by  side  the  incidence  figures 


78 


THE    PEOBLEM   OF   THE   NATIONS 


per  1,000 

per  1,( 

5 

— 

2 

2 

5 

2 

5 

4 

18 

17 

22 

12 

27 

13 

2 

39 

— 

35 

of  seven  cities  which  I  have  already  given,  and  the  figures  which 
one  would  expect  : — 

„  ,  Incidence  as  calculated    Progression  basis 

City- 
Melbourne 
Christiania 
Bucarest 
Copenhagen 
Berlin 
Moscow 
St.  Petersburg 
New  York 
County  of  London 

Not  very  satisfactory,  is  it  ?  Although  three  of  the  cities,  including, 
curiously  enough,  Berlin,  give  almost  even  results.  Thirty-five  per 
thousand  for  London  is,  I  think,  quite  impossible.  As  regards  the 
Kussian  cities  we  know  that  the  prevalence  there  is  abnormal. 

Most  authorities  upon  the  Continent  seem  to  think  that  there 
is  less  syphilis  in  London  than  in  Berlin  or  Paris.  I  am  a  little 
uncertain  why  they  should  think  so,  because  in  very  many  respects 
the  factors  which  tend  to  the  spread  of  the  infection  are  more 
numerous  and  more  serious  in  London  than  in  those  other  capitals. 
Some  of  these  I  have  already  indicated  {ante,  p.  66)  ;  and  it  should 
also  be  remembered  that  London  is  a  great  port  whither  come 
folk  from  every  country  in  the  world,  as  they  have  done  since 
London  was  a  wattled  village  : — 

'  And  Norseman  and  Negro  and  Gaul  and  Greek 
Drank  with  the  Britons  in  Barking  Creek,' 

The  serious  problem  of  unchecked  alien  immigration^  has  long 
since  been  recognized,  but  it  needs  a  visit  to  the  harbour  and  dock 
regions  of  our  ports  to  reahze  how  serious  a  factor  it  is  in  the 
propagation  of  disease.  Also  London  is  cursed  with  the  most 
unbridled  and  widespread  prostitution  of  any  city  in  the  world; 
and  our  laissez-faire  policy  in  this  and  in  any  attempts  at  checking 
sexual  disease  is  notorious. 

But — and  it  is  a  big  '  but ' — we  may  set  against  these  factors 
certain  of  our  racial  characteristics.  I  do  not  mean  to  suggest 
that  we  are  more  moral  than  our  neighbours,  because  I  do  not  think 
that  we  are.  Human  nature  is  much  the  same  all  over  the  world. 
But  we  have  a  different  way  of  looking  at  sexual  questions.  In 
some  respects  it  is  a  good  way,  in  others  it  is  a  bad  way.     It  is 

'  The  number  of  immigrants  into  the  United  Kingdom  during  the  years  1908-12 
is  given  as  nearly  1,600,000. 


THE    PREVALENCE    OF    SYPHILIS  79 

a  bad  way  when  it  degenerates  into  prudishness,  hypocrisy  and 
cant,  into  a  refusal  to  recognize  the  elementary  facts  of  sex  life 
and  the  need  of  teaching  them  to  our  children.  It  is  a  good  way 
when  we  find  our  young  men  regarding  women  as  but  incidents 
in  their  lives,  until  the  moment  when  they  may  give  their  whole- 
hearted devotion,  their  clean  passionate  love  to  "  the  one  in  the 
world."  And  that  is  the  big  fact  which  in  great  measure  out- 
balances all  the  rest. 

Your  French,  German  or  Eussian  student  sees  things  differently. 
He  is  improving,  according  to  our  standards,  because  he  wants  to 
be,  and  is  becoming  a  good  sportsman ;  and  you  cannot  ride  straight 
to  hounds,  or  row  in  the  Eights,  or  make  a  century  at  cricket,  if  you 
spend  your  evenings  in  a  cafe  or  a  girl's  bedroom. 

A  Britisher  does  not  talk  about  women  in  the  same  way  because 
he  does  not  think  of  them  like  that.  It  isn't  '  the  thing.'  There 
is  literally  no  comparison  between  Oxford  and  Cambridge  and  a 
Continental  university  town.  In  the  former  opportunities  for 
promiscuous  intercourse  hardly  exist,  in  the  latter  prostitution  is 
rampant.  So  long  as  our  young  men  maintain  the  fine  ideal  of 
being  '  sportsmen '  and  of  playing  the  game  for  their  side,  not 
looking  on  while  others  do  the  work,  so  long  will  they  be  the  envy 
of  their  contemporaries  across  the  water  in  their  freedom  from 
sexual  disease.  For  it  is  precisely  between  the  ages  of  18  and  25 
that  most  men  contract  syphilis. 

And  there  is  another  aspect  in  this  difference  of  outlook 
between  the  Anglo-Saxon  and  the  German  or  Frenchman  which 
I  do  not  think  has  ever  been  fully  recognized.  It  already  counts 
for  much  in  this  question  of  prevalence  of  disease,  but  it  might 
count  for  so  much  more.  The  young  French  or  German  of  the 
great  towns  is  apt  to  regard  every  woman  in  the  light  of  a  possible 
mistress.^    The  young  Anglo-Saxon — and  I  include  the  American — 

1  It  must  not  be  presumed  that  this  is  evidence  of  an  inferior  standard  of 
morality.  It  is  simply  a  question  of  the  difference  in  emotional  outlook  upon 
life  between  the  Anglo-Saxon  and  the  Teuton,  Latin  or  Slav.  This  same 
difference  is,  of  course,  to  be  observed  in  Literature  and  the  Fine  Arts.  One 
may  also  compare  the  fundamental  bases  of  the  Woman's  Movement  in  Ger- 
many and  England.  In  the  former  nation  the  movement  is  based  upon  emotion, 
the  desire  for  a  sexual  relationship  of  the  highest  character,  the  adequate  training 
of  the  children,  in  a  word,  the  "  home."  In  England  it  would  appear  to  be 
mainly  in  the  direction  of  the  suffrage.  Morality  is,  after  all,  a  matter  of 
geography.  Every  cominunity  adopts  the  form  which  it  considers  to  be  the 
most  suitable  to  its  needs. 


80  THE   PROBLEM   OF   THE   NATIONS 

generally  only  asks  for  a  girl  '  pal.'  In  other  words,  with  the  former 
it  has  come  by  force  of  habit  and  mode  of  thought  to  be  an  instinc- 
tive desire  for  sexual  intercourse,  to  him  the  obvious  and  natural  out- 
come of  friendly  relationship  with  a  woman ;  with  the  latter  it  is 
more  frequently  a  simple  sex-hunger.  I  could  give  so  many  instances 
of  this  simple  and  most  natural  desire  ;  I  will  merely  give  one 
illustration  which  must  appeal  very  forcibly  to  any  man  or  woman. 

In  Shanghai,  a  great  international  settlement,  there  are  some 
six  or  eight  "houses  of  ill-fame"  of  the  better  class  which  purport 
to  serve  the  desires  of  the  young  Britisher  or  German  or  American 
of  the  community.  Shanghai  knows  no  distinction  of  social  rank. 
If  a  young  fellow  is  a  sportsman  and  a  good  sort,  he  is  received 
everywhere  quite  irrespective  of  his  position  in  business  or  his 
monthly  salary. 

The  prostitutes  in  these  houses,  some  five  or  six  in  each,  are 
almost  invariably  English  or  American,  and  girls  of  some  educa- 
tion. In  each  house  there  is  a  fairly  large  room  which  is  used  for 
dancing.     Wine  and  spirits  are  sold,  of  course  at  a  big  profit. 

Now  here  there  is  every  possible  temptation  to  a  young  man  to 
indulge  his  sexual  appetite  ;  and,  further,  every  facility,  in  that  he 
need  not  pay  cash  down  for  his  pleasure,  but  has  only  to  sign  a 
"chit"  which  is  presented  for  payment  at  the  beginning  of  the 
following  month.  And  yet  over  and  over  again  I  have  known 
instances  of  our  young  fellow-countrymen  resorting  to  these  houses 
solely  for  the  sake  of  the  girls'  society,  a  couple  of  dances,  a  drink, 
perhaps  not  so  much  as  a  kiss,  and  so  back  to  their  own  homes 
none  the  worse  for  the  evening's  amusement. 

I  can  imagine  no  more  striking  illustration  of  the  young 
Britisher's  attitude  towards  women.  It  would  be  striking  enough 
in  London ;  but  east  of  Suez,  where  the  sexual  impulse  is 
enormously  strengthened,  it  seems  almost  incredible. 

I  would  not  appear  to  generalize,  but  would  merely  suggest  this 
aspect  of  the  case  for  consideration.  Where  there  is  real  freedom 
and  comradeship  between  the  sexes  as  in  America,  and  opportunities 
for  friendly  intercourse,  I  am  convinced  that  there  is  much  less 
desire  for  the  more  intimate  relationship.  Where  the  female 
element  is  non-existent  the  man  turns  to  the  women  of  the  streets, 
and  generally  with  disastrous  results. 

If  we  accept  this  view  of  the  Anglo-Saxon's  regard  for  women 
it  is  equally  applicable  to  our  soldiers  and  sailors.     With  compara- 


THE   PREVALENCE   OF   SYPHILIS  81 

tively  rare  exceptions  the  only  women  the  average  Tommy  meets 
are  those  of  the  lower  prostitute  class.  These  women  are  out  for 
business  only  and  the  man  does  not  escape.  But  in  my  experience 
there  is  not  more  than  one  man  in  ten  whose  primary  object  in 
seeking  some  female  society  is  a  desire  for  intercourse. 

During  the  last  year  or  so,  since  our  Fleets  have  been  concen- 
trated in  Home  waters,  the  marriage-rate  of  the  lower  deck  has 
increased  to  an  extraordinary  extent.  If  only  from  the  point  of 
view  of  the  checking  of  disease  this  is  all  to  the  good.  But  it  is 
also  very  significant  in  this  question  of  sex-hunger.  A  man  very 
rarely  marries  a  girl  to  satisfy  a  purely  physical  desire  of  her. 

This  may  seem  to  be  an  unnecessarily  lengthy  digression,  but 
it  all  bears  upon  our  study  of  the  prevalence  of  sexual  disease  in 
the  United  Kingdom.  We  have  come  to  see,  in  short,  that  if 
certain  conditions  tending  to  the  spread  of  infection  are  far  more 
grave  in  this  country  than  on  the  Continent,  yet  we  find  a  definite 
counterbalance  in  our  attitude  towards  sexual  matters  and  our 
women-folk. 

To  this  we  may  add  the  fact  already  noted  that  syphilis  is  far 
less  in  evidence  than  it  was  forty  years  ago  ;  and  also  that  in  our 
•country  districts  it  is  comparatively  unknown,  that  the  gradual 
ingress  into  the  great  towns  has  tended  to  eliminate  it — to  the 
detriment  of  the  town  populations.  We  have  also  noted  that 
many  of  the  very  serious  disorders  and  diseases  of  which  syphilis 
is  a  direct  or  indirect  cause  are  steadily  increasing.  This  latter 
is,  I  think,  almost  the  most  serious  fact  with  which  we  have  to 
deal,  for  it  indicates  an  increasing  number  of  cases  in  which  either 
there  has  been  no  treatment  or  the  treatment  has  been  inadequate. 
In  a  word  the  syphilis  has  been  driven  inwards — if  we  may  use  the 
expression — driven  inwards  until  it  has  secured  a  firm  and  immov- 
able grip  upon  the  constitution. 

Now  I  am  going  to  suggest  a  reference  back  to  the  table  on 
p.  73,  and  ask  whoever  may  be  sufficiently  interested  in  the 
problem  to  compare  the  figures,  to  bear  in  mind  all  these  various 
facts  and  to  draw  his  own  conclusions  as  to  the  prevalence  of 
syphilis  in  London  and  England  and  Wales. 

It  is  necessarily  guess-work,  and  I  am  going  to  make  a  guess 

based   simply   and    solely  upon   these    general    observations   and 

deductions,      I   estimate   the   prevalence   of   syphilis,    recent   and 

standing   cases,    to  be  in  London   about  12   per   1,000.      This   is 

6 


Aggregate 

Rate  per 

IS'mnber  of 

population 

1,000 

cases 

4,500,000 

12 

54,000 

1,986,900 

5 

9,935 

3,563,800 

2 

7,127 

4,300,000 

1 

4,300 

3,500,000 

0-SO 

1,750 

10,861,000 

0-25 

2,715 

82  THE   PROBLEM   Of   THE   NATIONS 

exclusive  of  allied  diseases,  but  it  includes  primary,  secondary  and 
tertiary  cases  in  the  same  way  as  indicated  in  the  Russian  statistics. 
If  anything,  I  have  underestimated  ;  I  am  certain  that  I  have 
not  exaggerated.  Let  us  then  see  how  many  cases,  approximately, 
this  figure  gives.  Eor  the  great  towns  I  am  going  to  calculate 
downwards  upon  the  basis  which  we  have  seen  holds  good  in 
Germany,  starting  with  the  Melbourne  and  Copenhagen  figure 
(5  per  1,000)  as  reasonable  for  the  towns  with  5  to  700,000 
inhabitants.  As  a  matter  of  fact  we  should  really  start  with  a 
considerably  higher  basis  than  5  per  1,000,  but  I  am  taking  the 
lowest  possible  estimate  : — 

(a)  1  city  of  more  than  1  million  inhabitants 

(b)  3  cities  of  more  than  500,000  ,, 

(c)  12  towns      „  ,,       200,000 
{d)  28       „         ,.          „       100,000  „ 
(e)  54       „         „          „         50,000 

(/)  Remainder  of  urban  districts         

Total         ...         79,827 

79,827  recent  and  standing  cases  out  of  an  urban  population 
in  England  and  Wales  of  28  millions,  or,  say,  3  per  1,000.  We  will 
allow  that  the  incidence  in  the  country  districts  is  negligible. 

This  is  syphilis  alone.  Now  take  careful  count  of  all  those 
allied  diseases  which  I  have  mentioned,  the  increase  in  the 
nmnber  of  mentally  deficient  and  paralytic  cases,  aneurysm  and 
diseases  of  the  blood-vessels  (5,177  deaths  in  1911)  ;  congenital 
diseases  in  children  and  the  infantile  mortality  rate  from  syphilis, 
deafness  and  blindness,  and  all  the  rest.  Who  will  hazard  any 
guess  at  the  figures  ?  Then,  after  all  this,  we  have  still  gonorrhoea 
to  reckon  with,  and  gonorrhoea  is  perhaps  three  times  as  prevalent 
as  syphilis,  and  probably  every  man  is  infected  at  least  once  in  his 
life.  We  shall  thus  he  arriving  at  a  figure  of  a  third  of  a  million 
cases  of  sexual  disease  in  England  and  Wales,  at  the  lowest  of 
estimates. 

Dr.  Douglas  White,  giving  evidence  before  the  Royal  Commis- 
sion, in  March,  1914,  estimated  that  there  were  every  year  122,500 
fresh  cases  of  sexual  disease  in  London  alone,  and  800,000  in  the 
United  Kingdom  ;  of  these  114,000  would  be  syphilis.  From  these 
figures  he  deduced  that  there  must  be  in  the  United  Kingdom  some 
3  million  syphilitics.  It  will  be  noted  that  so  far  as  London  is 
concerned  my  own  estimate  is  approximately  the  same. 


83 


VIII. 
SUMMAEY  AND   CONCLUSION. 

There  I  think  we  may  leave  it.  Whatever  the  approximate 
figures  may  be,  it  must  be  obvious  to  anyone  v^^hc  has  follovv^ed  the 
estimates  vs^hich  I  have  attempted  to  make  that  civihzation  has  got 
to  face,  vt^ithout  further  delay,  a  plague  of  the  first  magnitude 
I  have  tried  to  indicate  the  exact  nature  of  the  symptoms  of  gonor- 
rhoea and  syphilis,  and  from  thence  its  effect  upon  the  individual. 
I  have  tried  to  show,  with  a  little  success,  I  hope,  that  science 
is  able  to  deal  successfully  with  these  diseases,  and  effectively  to 
arrest  their  development,  if  only  the  patient  loill  consent  to  careful 
treatment  immediately  he  discovers  or  suspects  that  he  is  infected. 

Salvarsan  Treatment. — I  am  well  aware  that,  so  far  as  syphilis 
is  concerned,  there  is  no  little  discussion  about  the  real  effects  and 
the  possible  dangers  of  the  salvarsan  treatment.  Whenever  a  case 
occurs  of  "  injurious  effects  from  salvarsan  "  it  is  magnified  out  of 
all  proportion  and  eagerly  seized  upon  and  quoted  by  the  opposi- 
tion. Personally,  I  am  content  to  pin  my  faith  to  the  results  of 
the  treatment  obtained  in  our  Army  Medical  Service,  a  Service 
which  is  fully  recognized  all  the  world  over  as  second  to  none  in 
its  splendid  fight  against  sexual  disease.  I  submit  that  the  public 
is  justified  in  placing  the  fullest  confidence  in  a  treatment  which, 
as  Major  W.  S.  Harrison,  E.A.M.C,  has  definitely  asserted,  has  been 
applied  in  3,000  cases  at  Eochester  Eow,  London,  without  a  single 
death  resulting  nor  indeed  any  ill-effects.  And  similar  over- 
whelming evidence  is  forthcoming  from  other  countries. 

Professor  Wechselmann,  of  Berlin,  who  was  the  first  to 
administer  Ehrlich's  remedy  in  hospital  work,  records  that  he  has 
given  45,000  injections  and  stoutly  denies  that  it  is  a  poison.^  One 
death  only  had  resulted,  and  that  was  in  a  case  where  mercurial 
treatment  had  also  been  applied. 

'  British  Medical  Journal,  March  14,  1914. 


84  THE   PROBLEM   OF  THE   NATIONS 

Dr.  Jeanselme,  of  Paris,  the  first  medical  man  in  France  to 
administer  the  treatment,  has  said  that  the  surest  proof  of  the 
efficacy  of  salvarsan  was  that  during  his  three  years'  experience 
of  its  application  he  had  known  four  unquestionable  cases 
of  re-infection.  In  his  twenty-five  years  of  previous  medical 
experience  he   had    never  seen  a   single   one/ 

How  can  I  emphasize  sufficiently  the  immediate  and  admirable 
results  which  a  patient  will  find  in  this  treatment  ?  Sometimes  I 
am  in  despair  that  the  public  will  ever  realize  how  easy  it  is  to 
deal  with  syphilis  in  its  early  stages. 

Only  this  year  a  young  fellow  of  21  spoke  to  me  of  a  syphilis 
which  he  had  contracted.  He  was  cramming  for  the  Army,  and 
was  engaged  to  be  married.  It  was  by  the  merest  chance  that  he 
mentioned  it,  and  he  had  actually  made  up  his  mind  to  take  an 
overdose  of  chloral,  in  the  firm  conviction  that  his  life  was  ruined. 
He  was  soon  persuaded  of  his  madness ;  and  the  treatment  is 
proving  all  that  could  be  desired  if  only  he  will  persist  in  it.  There 
must  be  hundreds  of  such  cases  in  a  year  ;  young  men  who  are 
terrorized  by  vague  stories  of  the  results  of  syphilis,  and  know 
literally  nothing  of  the  possibility  of  cure.  Is  not  this  alone  a 
sufficient  plea  for  the  education  of  the  individual  ? 

Still  keeping  to  the  individual  aspect,  I  have  then  tried  to  show 
something  of  the  results  of  syphilis,  the  great  variety  of  diseases 
which  may  attack  the  individual  as  the  outcome  of  his  neglect  and 
indifference  to  treatment.  Then  I  have  spoken  of  syphilis  in 
relation  to  marriage  and  the  family  ;  the  insensate,  criminal  folly 
which  permits  a  man  to  inflict  so  hideous  a  gift  upon  an  innocent 
woman,  and  so  upon  his  children. 

I  have  written  of  the  effect  of  syphilis  upon  innocent  children. 
The  writing  of  that  chapter  was  one  long  nightmare.  The  facts 
had  to  be  faced,  but  I  pray  that  I  may  never  be  set  another  such 
a  task. 

I  have  touched  briefly  upon  the  question  of  "  innocent  con- 
tagion," and  it  is  sincerely  to  be  hoped  that  the  illusion  of  sexual 
disease  being  "a  just  retribution  of  sin"  is  dispelled  once  and 
for  all. 

Finally,  I  have  attempted  to  indicate,  by  the  previous  chapter, 
the  effects  of  syphilis  upon  the  race  and  upon  civilization. 

'   The  Times,  February  3,  1914. 


SUMMARY  AND   CONCLUSION  85 

Here,  then,  are  the  facts.  What  is  going  to  be  done  ?  What 
is  the  solution  of  the  problem,  the  "  Problem  of  the  Nations  "  ? 

I  set  out  to  write  these  articles  with  the  one  fact  clearly  in  my 
mind,  that  the  solution  is  to  be  found  only  in  bringing  home  to  each 
individual  member  of  the  community  the  exact  meaning  of  sexual 
disease.     If  there  is  another  and  better  one  let  it  be  proposed. 

How  that  education  may  be  effected  is  a  matter  for  individual 
and  collective  effort,  we  cannot  rely  upon  the  State.  That  it  is 
possible,  indeed  comparatively  easy,  I  have  already  suggested. 

The  first  thing  to  be  done  is  undoubtedly  to  educate  men  and 
women  how  to  carry  on  the  work  of  education.  The  details  need 
not  be  discussed  here.  The  provision  of  facihties  for  treatment  is 
then  the  concern  of  the  State,  of  Local  Authorities,  and  of  the 
Medical  Profession.  The  technique  of  treatment  is  by  no  means 
easy;  the  Profession  must  see  to  it  that  their  members  receive 
careful  instruction. 

The  campaign  against  cant  and  any  "  conspiracy  of  silence " 
must  be  continued  with  ever-increasing  vigour.  This  plague  has 
got  to  be  wiped  out  of  existence,  and  to  do  so  we  must  have  clean 
and  frank  discussion.  It  concerns,  directly  or  indirectly,  every 
man  and  woman  in  the  country,  in  the  world,  for  it  is  based  upon 
the  most  elemental  facts  of  human  existence,  sexual  impulse  and 
motherhood. 

There  is  no  question  of  appeal  to  sentiment,  and  I  make  none, 
save  on  one  score  only,  that  of  the  children.  If  that  appeal  fails, 
and  a  father  or  mother  is  content  to  create  a  life  condemned  to 
lingering  agony,  then  such  a  person  is  fit  only  to  be  hounded  out 
of  the  community,  for  he  is  no  human  being. 

Nor  is  there  any  appeal  to  patriotism  and  pride  of  race.  If 
a  man  or  woman  will  not  do  a  thing  for  the  sake  of  himself 
and  his  own  flesh  and  blood  he  is  not  likely  to  bother  about  his 
country. 

But  let  us  look  at  the  question  simply  from  the  point  of  view  of 
practical  common-sense.  Take  a  young  fellow  who  is  just  leaving 
school  for  the  University,  or  to  enter  some  business  firm.  From 
the  more  or  less  sheltered  cloister  of  the  school  he  will  be  plunged 
direct  into  the  great  world.  He  will  be  brought  face  to  face  with 
a  new  element,  "woman,"  and  he  is  practically  certain  to  seek 
opportunity  to  follow  the  sexual  impulse.  The  chances  are  that, 
through  ignorance,  his  first  experience  may  prove  disastrous. 


86  THE    PROBLEM   OF   THE    NATIONS 

Now,  putting  the  question  to  his  father  as  a  business  man,  which 
is  the  better  alternative  to  follow  : — 

(a)  Avoid  the  subject,  let  your  boy  *  gang  his  ain  gait '  and  run  his 
own  risks.  Let  him  be  faced  with  a  possible  attack  of  syphilis  which 
he  is  certain  to  conceal,  and  which  will  perhaps  drive  him  to  contem- 
plate suicide  (as  my  friend  did).  Let  him  get  married,  perhaps,  in  an 
infected  state,  with  all  the  horrible  results — and  you  know  that  to  have 
a  grandchild  is  your  dearest  wish — or, 

(b)  Have  half-an-hour's  chat  with  him  as  his  best 'pal.'  Let  him 
see  that  you  were  once  young  yourself  and  know  all  about  his  feelings. 
Tell  him  that  there  is  not  the  least  physical  reason  why  he  should  have 
anything  to  do  with  women,  that  he  will  be  ever  so  much  better  without 
them,  that  no  one  whose  opinion  is  worth  counting  will  think  any  the 
better  of  him  for  trafficking  with  prostitutes.  Give  him  some  idea  of  the 
risks  he  would  be  running,  to  himself,  to  his  future  wife,  to  his  children. 
And,  finally,  if  after  all  it  should  be  necessary,  tell  him  that  his  only 
chance  is  to  go  straight  off  to  the  best  medical  man  he  knows. 

Which  is  it  to  be  ?  At  least  the  latter  is  worth  a  trial,  and 
it  will  do  no  harm.  More,  it  will  probably  be  the  means  of  making 
you  and  your  boy  friends  for  life,  and  that  alone  is  worth  an  effort. 

Again  I  would  urge  that  the  attempted  teaching  of  abstract 
morality  is  a  sheer  waste  of  time.  Indeed  it  is  more  than  this, 
it  is  wrong.  Before  we  do  so  Society  must  be  regenerated,  else  we 
impose  upon  youth  a  burden  too  heavy  for  him  to  bear. 

But  practical  morality  is  a  different  thing.  We  can  and  should 
urge  the  value  of  abstinence.  It  is,  I  think,  agreed  that  in  this 
country,  and  in  these  latitudes  generally,  a  young  woman  does  not 
attain  to  her  full  maturity  of  sex  until  she  is  20,  and  a  young 
man  until  he  is  about  25.  Up  to  this  age  a  man  seldom  experi- 
ences the  full  driving  force  of  sexual  impulse ;  it  is  a  power  of 
moods  and  moments  only. 

Unfortunately  we  have  also  to  recognize  that  it  is  before  these 
ages  of  sex  maturity  that  a  man  or  woman  generally  contracts 
disease.  This  fact  is  borne  out  in  every  country  by  statistics  and 
expert  opinion. 

Opportunity  and  alcohol  are  the  two  panders  to  irregular 
intercourse  in  the  case  of  a  young  man.  If  we  would  have  our 
sons  to  run  straight  in  this  matter  of  sex  we  must  first  see  to  it 
that  their  general  training  is  sound  and  wise.  And  the  two 
factors   upon    which   I   would    lay   stress   are    these.      First,   the 


SUMMARY  AND   CONCLUSION  87 

imparting  from  an  early  age  of  a  graduated  knowledge  of  sex 
fmictions  and  hygiene.  There  must  be  no  secrecy  nor  reservation 
about  this  most  vital  of  all  subjects.     Why  should  there  be  ? 

Once  again,  a  father  is  presented  with  a  choice  between  two 
alternatives.  Either  his  boy  will  learn  the  facts  in  a  clean  healthy 
way,  and  so  will  come  to  regard  the  subject  as  the  natural  and 
wonderful  thing  it  is.  Or  he  will  acquire  a  most  harmful  and 
distorted  view  of  it  from  the  loose,  ignorant  talk  of  his  companions. 
Surely  no  father  would  hesitate  to  choose  the  first  for  his  son. 
The  ennobling  influence  which  such  wise  knowledge  would  bestow 
remains  and  directs  a  man  throughout  his  life. 

The  second  factor  is  the  cultivation  in  every  way  possible 
of  a  love  of  the  open  air,  and  I  mean  this  in  its  broadest  sense. 
Great  Britain  owes  her  supremacy  in  the  world  to  the  love  of  the 
Open  Life  engendered  in  her  men  and  women.  If  that  love  ever 
becomes  stifled  by  the  smoke  and  dust  of  encroaching  city  life 
we  shall  begin  to  go  downhill.  The  man  who  hearkens  to  the 
call  of  the  sea,  who  understands  the  language  of  the  murmuring 
forest,  who  responds  to  the  touch  of  the  myriad  invisible  things 
by  moorland,  mountain  and  field,  that  man  sees  deep  into  the  heart 
of  life.  Of  such  stuff  our  Empire  builders  are  made.  Strathcona, 
Kitchener,  Scott,  and  a  thousand  others  who  work  or  have  worked 
for  England  on  the  confines  of  her  Empire  owe  their  knowledge  of 
human  nature  and  unerring  grasp  of  detail  to  their  love  of  the  Open. 

The  language  of  the  Open  is  the  surest  passport  to  the  heart 
of  the  great  public.  Lord  Salisbury  knew  this  when  he  told  his 
fellow-countrymen  that  they  were  "  putting  their  money  on  the 
wrong  horse."  We  read  of  the  latest  despicable  outrage  by  a 
militant  suffragette  and  we  say,  "It's  not  cricket."  Wellington's 
remark,  if  he  ever  made  it,  about  the  "  playing-fields  of  Eton  " 
has  created  a  deal  of  discussion,  but  it  struck  right  home. 

Educate  our  sons  to  love  the  Open  Life  and  to  be  sportsmen 
and  we  shall  send  them  out  into  the  world  well  armed  and 
equipped  for  any  work,  professional,  commercial  or  political.  And 
especially  so  in  this  matter  of  sex. 

A  young  fellow  who  is  a  sportsman  will  "  play  the  game  "  all 
the  harder  in  his  work.  And  if  he  does  this  he  will  have  very 
little  time  or  inclination  to  go  petticoat-hunting  or  drinking  in 
saloon-bars.  In  the  German  Army  a  man  is  kept  hard  at  it  from 
morning   to   night.      He   has   little  opportunity   to   bother   about 


88  THE    PROBLEM   OF   THE   NATIONS 

women,  and  he  turns  in  early  and  sleeps  as  soundly  as  he 
works. 

But  our  two  factors  will  not  meet  every  contingency.  So  we 
will  add  a  third  by  adopting  the  motto  of  the  Boy  Scouts,  "  Be 
prepared."  If  these  three  formed  the  basis  of  a  system  of 
universal  education  what  a  nation  ours  would  be. 

This  to  the  fathers ;  what  suggestion  can  be  made  for  the 
mothers  and  daughters  ? 

In  the  first  place  a  mother  must  instruct  her  daughter  in  the 
elemental  facts  of  sex  and  sexual  life.  Surely  there  are  no  longer 
two  opinions  as  to  the  wisdom  of  such  a  course  where  girls  are  con- 
cerned. This  is  not  the  place  to  enlarge  upon  a  question  with  which 
we  are  not  for  the  moment  concerned.  But  if  such  instruction  is 
given  at  a  reasonable  age,  in  the  proper  manner,  and  with  a  deep 
sense  of  noble  purpose,  I  can  conceive  no  valid  argument  which 
can  be  brought  forward  against  it.     I  could  give  fifty  in  support. 

But  sexual  disease  is  rather  different.  My  own  feeling  in  the 
matter  (I  give  it  for  what  it  is  worth)  is  that  there  appears  no 
actual  necessity  for  a  girl  to  know  the  details.  I  speak  now  of 
the  average  girl  of  the  middle  and  upper  classes.  But  there  is  no 
particular  objection  to  a  girl  knowing  the  broad  facts  without 
a  mass  of  detail,  and  the  knowledge  would  certainly  prove  a  great 
safeguard  and  a  deterrent  in  certain  eventualities. 

It  will  seem  that  I  draw  too  wide  a  distinction  between  the 
sexual  lives  of  men  and  women.  I  do  not  forget  for  a  moment  the 
tendency  of  the  present  age  to  a  genuine  sex  equality  in  the  physical 
relationship,  with  or  without  a  recognized  form  of  contract,  but 
a  woman  is  of  a  more  sensitive  and  delicate  fibre  and  the  know- 
ledge might  have  a  harmful  effect.  It  is,  after  all,  the  man's 
business  to  see  that  he  gives  himself  to  the  woman  of  his  choice 
in  precisely  as  sound  a  physical  condition  as  he  expects  to  find 
in  her. 

I  have  sought  the  opinion  of  several  women  of  education  and 
knowledge  of  the  world,  and  I  must  confess  that,  without  exception, 
they  have  advocated  imparting  this  knowledge — of  course  at  a 
proper  age.  And  their  main  reason  may  be  summed  up  in  the 
words,  "  It  will  frighten  her." 

It  is  a  little  difficult  to  decide,  and  the  solution  may  be  left  to 
the  good  judgment  of  the  many  women  who  with  single-minded 
purpose  are  devoting  their  lives  to  the  increasing  welfare  of  their 


SUMMARY   AND    CONCLUSION  89 

sex  and  so  of  the  community.  This  is  the  real  end  in  view  for 
women,  not  the  attainment  of  the  suffrage.  The  latter  is  but  a 
very  problematical  means  to  a  part  of  the  end. 

Years  ago  Disraeli  remarked  that  measures  for  the  furtherance 
of  the  Public  Health  must  ever  take  precedence  of  all  other  social 
reforms.  The  sentiment  was  received  with  ridicule,  but  time  has 
justified  its  wisdom.  The  suppression  of  sexual  disease  will  be  the 
greatest  blessing  to  civihzation  which  preventive  medicine  can  ever 
bestow.  Not  only  will  it  be  the  greatest  of  all  achievements  in  the 
cause  of  Public  Health,  but  it  will  create  such  a  revolution  in  the 
social   life   that  no   man    can    foretell    how    far-reaching   may   be 

the  effects. 

Science,  the  magician,  has  it  in  his  power  to  create  a  new 
world — a  world  which  is  no  longer  "  such  stuff  as  dreams  are  made 
of,"  but  the  certain  achievement  of  practical  effort.  But  the 
miracle  will  not  be  wrought  unasked,  and  in  despite  of  the  peoples 
who  shall  benefit.  Like  the  Genie  of  the  Lamp,  the  magician  must 
first  be  invoked.  It  is  for  the  nations  to  decide  whether  he  shall 
be  summoned. 

And  the  name  of  the  Magic  Lamp  is  Knowledge.  How  may 
it  be  placed  within  the  grasp  of  every  man  and  woman  ?  There  is 
the  problem.     Will  you  help  to  solve  it? 


90 


IX. 
TO 

A   GODSON. 

WHEN    HE    IS     18    YEARS    OLD. 

My  DEAR  Hugh, 

It  is  just  eighteen  years  since  that  morning  when  I  stood  beside  your 
Mother,  as  she  held  you  in  her  arms,  and  took  for  you  the  vows  which  our 
Faith  enjoins.  That  afternoon  I  wrote  to  you  my  first  letter.  A  little  of  it 
I  can  remember.  "Tell  your  Father,"  I  said,  "to  teach  you  how  to  play 
with  a  straight  bat  and  to  stand  up  to  the  fastest  bowling;  how  to  ride  clean 
across  country  and  not  to  funk  the  fences;  how  to  bring  down  a  pheasant  coming 
fast  over  the  tree-tops  in  a  high  wind.  And  tell  your  Mother  to  teach  you, 
for  her  sake,  to  be  gentle  and  courteous  in  reverence  to  all  women." 

These  seemed  to  me  a  summing  up  of  the  qualities  which  go  to  the  making 
of  the  best  of  all  products,  an  English  Gentleman.  It  was  not  for  the  sake 
of  the  sport,  but  for  what  the  Open  Life  made  you.  And  given  these  qualities 
you  are  ready  to  face  anything,  in  Church,  State  or  Business. 

Now  you  are  shortly  leaving  the  best  of  schools  for  the  great  world  outside 
and  your  tussle  with  life.  And  you  are  going  to  encounter — not,  perhaps, 
just  yet,  but  in  a  year  or  two — one  of  the  biggest  factors  in  life,  the  other  sex. 
How  are  you  going  to  tackle  it? 

Of  course,  just  for  the  moment,  you  won't  understand.  You  cannot 
imagine  what  you  will  have  to  do  with  women  or  they  with  you,  at  least, 
to  make  a  serious  business  of  it.  I  know  when  I  was  at  school  we  used  to 
think  girls  a  rare  nuisance  and  we  never  used  to  talk  about  them,  I  don't 
suppose  things  have  very  much  changed,  have  they?  But  there  was  Miss 
Dorothy,  whom  you  met  last  holidays  down  in  Surrey,  an  "  awfully  decent 
sort,"  as  you  told  me.  I  know  she  is,  and  if  they  were  all  jolly,  healthy, 
out-of-door  girls  like  that  I  should  have  nothing  more  to  say,  and  I  certainly 
shouldn't  be  writing  this  letter.  But  I  am  afraid  that  Mistress  Dorothy  is 
rather  an  exception. 

Now  I  am  not  going  to  preach  to  you  about  what  you  ought  to  do  and 
what  you  ought  not;  I  have  never  done  that,  have  I  ?     I  just  want  to  tell  you 


LETTER   TO   A   GODSON  91 

a  few  facts  about  a  rather  unpleasant  subject  and  leave  the  rest  to  your  good 
sense.  Don't  imagine,  either,  that  I  am  going  to  write  you  an  essay  upon  that 
most  delightful  and  elusive  of  topics,  "  Woman."  For  one  thing  you  would 
only  be  terribly  bored,  and  for  another  every  man  has  to  find  these  best  things 
out  for  himself.  "  It's  mean  " — as  a  young  lady  once  remarked  to  me — "  to 
profit  by  other  people's  experiences;  I  want  to  profit  by  my  own." 

But  there  are  some  things  which  j^ou  will  not  find  out  for  yourself,  or  if 
you  do  it  will  probably  be  in  the  wrong  way  and  with  possibly  disastrous 
results.  It  is  just  those  things  that  I  want  to  tell  you  about  if  you  will  let 
me.  And  if  you  can't  quite  get  the  hang  of  it  all  right  away  just  put  this 
letter  down  and  read  it  again  in  a  year  or  so. 

*  *  * 

How  shall  I  begin?  It  is  a  little  difficult,  and  yet  not  so  difficult  as  it 
might  be  because  we're  starting  fair,  you  and  I.  We  talked  over  certain 
things  when  you  first  went  away  to  school.  Since  then  you  have  gradually 
come  to  understand  what  sex  means  and  there  is  nothing  more  to  tell  you  about 
the  simple  facts.  Every  young  fellow,  when  he  arrives  at  a  certain  age,  experi- 
ences some  more  or  less  certain  impulses  for  which  he  cannot  properly  account. 
There  is  nothing  whatever  to  be  ashamed  of  in  them;  they  are  perfectly  natural, 
and  girls  experience  them  in  much  the  same  way. 

But  up  to  now  there  has  been  no  opportunity,  and  probably  no  inclination 
on  your  part  for  directing  those  impulses  tov/ards  the  other  sex.  You  liked 
Miss  Dorothy  because  she  was  a  good  pal,  played  a  most  creditable  game  of 
golf,  and  made  a  jolly  good  innings  for  you  when  we  played  against  Deepcut. 
But  I'll  swear  that  you  never  wanted  to  kiss  her;  and  it  would  have  spoiled 
everything  if  you  had. 

Well,  now  you  are  going  to  face  life  in  reality.  You'll  find  yourself  with 
men  who  are  beginning  to  look  upon  girls  from  a  new  point  of  view.  You'll 
take  a  little  time  to  adjust  yourself.  But  I  shall  not  be  at  all  surprised  to  find, 
if  you  ask  me  to  lunch  in  your  new  quarters,  that  you  have  become  quite  an 
ardent  admirer  (from  a  platonic  standpoint,  of  course)  of  one  or  other  of  those 
extremely  pretty  young  ladies  who  dress  so  daintily  and  sing  so  charmingly  in 
"  The  Staircase  Girl."  No,  you  need  not  trouble  to  hide  their  photographs, 
because  if  you  do  I  shall  only  ask  to  see  them;  and  I  am  fairly  certain  to 
admire  your  taste.  After  all,  a  pretty  English  girl  is  one  of  the  loveliest 
things  God  ever  made,  and  if  they  are  not  to  be  admired  and  made  a  fuss  of 
(within  reason)  I  don't  quite  see  why  they  were  ever  created. 


92  THE    PKOBLEM   OF   THE    NATIONS 

But  coming  back  to  this  question  of  impulse,  it  seems  to  me  that  there 
arc  two  ways  in  which  a  young  fellow  feels  it.  The  one  is  a  simple  desire 
for  the  companionship  of  a  being  of  the  other  sex,  a  feeling,  an  attraction  which 
no  one  has  ever  properly  defined  and  no  one  ever  will.  This  we  may  call 
**  sex-hunger,"  for  want  of  a  better  term.  The  other  is  an  impulse  to  gratify 
the  sexual  appetite  by  actual  physical  intercourse  with  a  woman;  either  with 
some  particular  woman  or  with  women  as  a  sex. 

Do  you  quite  see  what  I  mean,  or  shall  I  try  and  put  it  a  little  more 
clearly?  Mind  you,  both  these  impulses  are  perfectly  natural.  If  anyone 
tells  you  that  the  former  is  natural  and  proper,  and  that  the  latter  is  unnatural 
and  wrong,  then  he  has  not  grasped  the  rudiments  of  human  nature.  The 
sexual  impulse  is  the  greatest  of  all  natural  laws.  It  is  wrong  only  when  it 
is  used  unworthily  and  to  base  ends. 

I  am  going  to  say  very  little  about  "sex-hunger"  because,  in  one  sense, 
there  is  very  little  to  say.  You  are  quite  capable  of  looking  after  yourself. 
Some  men  feel  the  need  of  female  companionship  more  than  others.  It  rather 
depends  on  your  general  line  of  work  and  how  fully  you  are  occupied.  In 
any  case  you  are  certain  to  find  a  big  difference  when  your  hard  physical 
exercise  is  cut  off,  a  big  gap  to  be  filled.  You  must  keep  up  your  cricket 
and  football  as  long  as  you  can  after  you  leave  school.  If  you  are  working 
hard  and  manage  to  get  in  a  fair  amount  of  exercise  you  will  be  happy  enough. 
Go  and  visit,  too,  at  a  few  good  houses  and  meet  nice  people.  Cultivate  the 
acquaintance  of  a  few  charming  women,  pay  little  attentions,  and  so  on,  and 
you  will  probably  find  as  much  female  companionship  as  you  want. 


I  must  confess  that  I  am  a  great  believer  in  freedom  and  comradeship 
between  men  and  women.  Each  sex  reacts  upon  the  other,  each  learns  from 
the  other,  and  this  is  all  to  the  good.  If  a  young  fellow  has  been  brought 
up  with  a  love  of  the  open  air — and  it  is  this  love  which  makes  the  Britisher 
what  he  is — I  can  see  no  danger  in  his  comradeship  with  a  nice  girl.  Such 
a  man,  too,  is  generally  rather  fastidious  in  his  choice.  He  will  never  be 
really  content  in  carrying  on  a  flirtation  with  a  golden-haired  maiden  in  a 
photographer's  shop,  or  v/ith  a  waitress  in  his  favourite  tea-shop.  It  really 
isn't  worth  it. 

Of  course  you  will  have  your  little  love  affairs,  passing  moments  of  delicious, 
stolen  joys.  You  need  not  fear  for  my  sympathy.  When  I  was  about  your 
age  I  remember  that  my  affections  were  fairly  equally  divided  between  a  lady, 
who  was  perhaps  ten  or  twelve  years  older  than  I,  and  a  girl  {very  beautiful 


LETTER   TO   A   GODSON  93 

I  then  thought  her)  whom  I  met  at  Earl's  Court  Exhibition.  The  former 
relationship  did  me  a  world  of  good,  and  I  am  proud  to  think  that  even  after 
all  these  years  we  are  still  dear  friends.  The  latter  affair  came  to  an  untimely 
end  when  the  young  lady  prevailed  upon  me  to  visit  her  people;  I  think  they 
kept  a  stationer's  shop  in  Chelsea. 

But  if  you  are  working  and  living  alone  in  London  and  you  don't  get  much 
exercise  and  you  are  rather  cut  off  from  pleasant  female  society,  then  I  see 
danger  ahead.     And  this  brings  me  to  the  other  kind  of  impulse. 


Sex-hunger  and  sexual  impulse  are  each  parts  of  the  great  law  of  Sex 
Attraction,  but  there  is  a  certain  difference  between  them  although  it  is  difficult 
to  define.  As  I  honestly  believe,  and  I  say  this  in  all  reverence,  the  Creator 
bestowed  this  sexual  impulse  upon  man  that  it  might  serve  two  ends.  The 
first  is  the  reproduction  of  life,  and  the  second  is  that  it  might  form  the 
supreme  manifestation  of  love  between  man  and  woman.  The  world  must 
recognize  the  first,  it  does  not  always  recognize  the  second. 

Different  peoples  have  different  standards  of  morality  upon  the  relation- 
ship of  the  sexes.  What  is  regarded  as  quite  ordinary  in  a  certain  country 
on  the  Continent  is  looked  upon  as  most  immoral  in  this  country.  And  certain 
habits  and  customs  which  we  British  never  think  about  because  they  are  prac- 
tically a  part  of  our  everyday  life — these  would  be  regarded  as  grossly  immoral 
by,  say,  the  Chinese.  It  comes  to  this,  that  in  this  question  of  morality  you 
must  abide  by  the  customs  of  the  society  in  which  you  live  or  take  the  conse- 
quences. In  the  same;  way  you  may  saunter  across  one  of  the  pleasant  tracts 
of  grass  in  Hyde  Park,  but  if  you  go  to  Berlin  and  indulge  in  a  similar 
recreation  in  one  of  the  parks  there  you  will  be  fined  a  few  marks  for  the 
privilege. 

But  a  man  is  not  apt  to  bother  very  much  about  the  morality  oi  the  act 
when  his  sexual  impulse  drives.  I  may  be  accounted  somewhat  of  a  revolu- 
tionary, but  I  hold  that  to  sin  against  Love  and  one's  own  conscience  is 
graver  far  than  to  sin  against  the  morals  of  the  society. 


And  so  I  put  the  matter  to  you  from  this  point  of  view  first  of  all.  You 
are  given  a  very  wonderful  and  beautiful  thing.  Are  you  going  to  abuse  the 
gift  and  drag  it  through  the  mire,  or  carefully  cherish  it  until  you  may  place 
it  to  the  noble  uses  for  which  it  was  given  ?  If  the  former,  you  will  experience 
some  brief  moments   of   mad,   sensual  passion,    with    immediate  and   unfailing 


94  THE    PROBLEM    OF   THE    NATIONS 

self-reproach  and  self-disgust;  if  the  latter,  you  will  realize  all  the  ecstasy  of 
the  most  perfect  thing  in  life,  the  clean  and  passionate  intimacy  of  union  in 
all  its  freshness  with  the  woman  whom  you  come  to  love  and  make  your  wife. 

Does  this  seem  too  ideal  a  programme?  Well,  youth  is  the  age  of  ideals. 
It  may  be  difficult  to  carry  out  but  it  is  by  no  means  impossible,  and  at  least 
it  is  worth  setting  before  yourself.  You  will  come  to  understand  better  as  the 
years  pass.     Now  we  will  turn  to  hard  facts. 


After  you  have  knocked  about  the  world  for  a  little  you  will  very  naturally 
ask  me  why  I  would  attempt  to  deny  you  an  experience  which  most  other 
young  men  indulge  in.  You  will  say  that  you  probably  will  not  be  in  a 
position  to  marry  for  at  least  another  ten  years.  Am  I  going  to  condemn  you 
to  a  celibate  life  all  those  years  and  stifle  what  I  admit  to  be  a  natural  impulse  ? 
That  the  experience  will  do  you  no  harm;  that  you  must  learn  what  life  means; 
these  and  other  like  arguments. 

Yes,  that  question   has  been   put  by   thousands  of   young   fellows  to   men 

who  are  far  better  qualified  than  I  am  to  reply  to  it,  and  I  do  not  believe  that  a 

satisfactory  answer  can  ever  be  given.     I  am  young  enough  to  remember  vividly 

my  own  youth  with  all  its  desires  and  impulses,  and  yet  old  enough  to  have 

seen  more  of  the  world  and  of  men  and  women  than  most  can  crowd  into  a 

life-time.     And  so  I  am  not  going  to  say  hardly  and  definitely  ' '  Thou  shalt 

not,"  nor  tell  you  that  it  is  morally  wrong  or  anything  like  that.     But  I  am 

going  to  answer  your  argument  in  the  approved  Irish  fashion  by  setting  another 

one  before  you  for  you  to  solve.      In  a  word  I  am  going  to  try  to  show  you 

the  other  side  of  the  picture  and   then   leave  the  whole  matter  to   your  own 

practical  common-sense. 

*•  -*  * 

Someone  will  perhaps  tell  you,  or  you  may  come  to  think  it  for  yourself, 
that  continence  (or  abstention  from  sexual  intercourse)  is  apt  to  be  physically 
hcirmful  to  a  man.  Such  an  idea  is  absolutely  and  entirely  wrong.  I  believe 
that  Nature  has  made  one  or  two  mistakes,  but  she  certainly  has  not  made 
one  in  this. 

The  harm  is  supposed  to  arise  from  the  overmuch  accumulation  of  semen, 
the  discharge  of  which  at  such  times  does  indeed  give  relief.  But,  as  you 
know.  Nature  has  provided  what  we  may  call  a  safety-valve,  and  if  this  does 
not  act  normally  at  proper  intervals,  then  I  think  that  it  is  a  matter  for  medical 
advice.     The  temporary  discomfort  is  a  very  trifling  affair  beside  that  which 


LETTEK   TO   A   GODSON  95 

every  woman  experiences  each  month.  And  I  do  beg  you,  old  man,  not  to 
imagine  that  you  ought  to  seek  relief  in,  shall  we  say,  an  irregular  way.  I 
assure  you,  and  I  know  that  I  am  well  backed  by  medical  opinion,  that  there 
is  absolutely  no  necessity.  I  admit  that  the  sexual  impulse  is  strongest  at 
those  times,  but  the  remedy  lies  in  your  own  hands.  If  you  fight  it  down 
once  or  twice,  throw  yourself  into  some  extra  hard  work,  get  a  long  day  on  the 
golf-links,  or  a  good  tramp  across  Surrey  commons,  you  will  find  that  things 
come  to  adjust  themselves  quite  easily.  Above  all,  keep  away  from  "The 
Staircase  Girl  "  and  such  like  performances,  and  don't  read  erotic  books. 


Now  we  will  imagine  that  one  evening  things  are  too  strong  to  resist  even 
with  a  fight.  I  can  see  you  throw  your  books  across  the  room  unable  to  con- 
centrate on  anything.  You  feel  that  you  simply  must  go  and  face  the  unknown. 
Or  perhaps  you  have  had  a  particularly  good  dinner  at  the  Trocadero  and 
three  or  four  of  you  are  going  to  have  a  really  jolly  evening  of  it.  You'll 
probably  look  in  at  the  Empire,  there  will  be  more  drinks,  and  before  you 
know  where  you  are  you  will  find  yourself  talking  trivial  nonsense  to  a  beauti- 
fully gowned  young  woman  who  naively  suggests  that  you  see  her  home. 
Why  not?  What  does  anything  matter?  You  are  feeling  like  the  mouse  who 
got  tipsy  over  a  puddle  of  whisky  and  then  sat  up  and  said,  "  Where's  that 
damned  cat  that  chased  me  yesterday  ?  ' ' 

I  am  imagining  your  first  serious  attempt  to  realize  this  big  thing  of  life. 
And  as  it  is  the  first  it  is  ten  chances  to  one  that  you  fall  into  the  hands  of 
an  ordinary  professional  prostitute,  and  not  one  of  the  better  class,  either. 
Well,  you  are  making  a  mistake  to  start  with.  What  you  really  desire — and 
I  see  you  as  a  clean-limbed,  healthy  young  Englishman — is  the  gratification 
of  your  appetite  under  the  glamour  of  love.  You  want  to  feel  that  the  woman, 
whoever  it  is,  gives  herself  to  you  because  she  is  attracted  by  you,  by  your 
pleasant  talk,  by  your  good  looks.  You  will  be  disappointed.  A  prostitute 
is  out  solely  to  make  money.  It  is  with  her  as  regular  a  trade  as  the  selling 
of  potatoes  is  to  the  greengrocer  at  the  corner.  She  has  got  to  live,  pay  an 
exorbitant  rent  for  her  rooms,  buy  good  clothes,  and  so  she  must  needs  make 
as  much  money  as  she  can.     She  cannot  afford  to  be  generous. 

It  is  to  her  interest  to  counterfeit  love,  to  act  a  comedy  for  your  particular 
edification.  But  you  will  not  be  deceived.  In  any  case  you  will  quickly  be 
disillusioned  when  it  comes  to  the  sordid  business  of  paying  in  hard  cash  for 
your  few  hours'  amusement.  And  probably,  seeing  that  you  are  a  novice  at 
the  game,  she  will  attempt  to  extort  every  penny  she  can.     Do  not  blame  her. 


96  THE   PKOBLEM   OF   THE   NATIONS 

it  is  her  trade.  Men  made  her  what  she  is;  she  is  absolutely  right  to  repay  her 
debt,  with  interest. 

I  am  not  going  to  paint  for  you  all  the  mean  and  shabby  details  of  your 
business  deal.  You  will  have  experienced  in  a  very  tentative  way  the  thing 
which  you  set  out  to  experience  and  the  net  result  will  be,  for  the  woman, 
two  or  three  pounds  in  pocket;  for  you,  the  loss  of  so  much  good  money 
which  you  can  ill  afford,  no  real  physical  satisfaction,  but  merely  a  feeling 
of  deep  disgust  at  yourself  and  a  longing  to  kick  yourself  downstairs. 

You  do  not  believe  me?  Very  well,  try  it;  and  if  you  prove  me  wrong 
I  promise  to  pay  for  your  evening's  amusement,  and  any  expenses  which  you 
may  be  put  to  as  the  consequences  of  it.  Yes,  "  consequences  " — for  I  have 
only  suggested  what  your  feelings  will  be  as  the  immediate  result  of  your 
experience.      Now  you  shall  hear  what  some  of  those  consequences  may  be. 

*  *  * 

There  are  certain  diseases  which  a  man  is  liable  to  acquire  from  sexual 
intercourse  with  a  prostitute;  we  call  them  "  venereal,"  or  "  sexual  "  diseases. 
And  if  I  were  disposed  to  back  your  chances  against  infection  in  such 
a  first  experience  as  I  have  described  I  would  not  take  odds  at  1 00  to  1 . 
The  two  special  diseases  are  "  Gonorrhoea  "  and  "  S3T5hilis,"  and  you  may 
have  contracted  either.  I  will  take  each  separately  and  tell  you  a  little  about 
them. 

You  will  know  within  a  week  whether  it  is  gonorrhoea,  in  its  more  usual 
form.  There  will  be  a  dull  aching  in  the  groins,  and  a  yellowish,  matter-like 
discharge  from  the  inflamed  urethra.  You  will  naturally  be  a  little  alarmed, 
and,  in  a  few  days  more,  as  you  go  about  your  ordinary  business  and  eat  and 
drink  as  usual,  you  will  find  things  beginning  to  look  serious.  Then  you  will 
probably  mention  it  to  an  acquaintance,  for  you  won't  care  to  tell  your  father 
or  me. 

"  Oh,  that's  all  right,"  he  will  say — "  it's  quite  simple.  Everybody  gets 
it  and  we'll  cure  it  in  no  time."  He  will  tell  you  to  go  to  a  chemist  and  ask 
for  a  certain  drug  and  then  follow  the  directions.  If  he  has  told  you  the  right 
thing  and  you  follow  the  instructions  with  scrupulous  care,  you  may  find  that 
the  symptoms  disappear  in  a  fortnight  or  so.  Then  you  will  stop  the  treatment 
and  go  on  with  your  usual  life.  If  the  attack  was  a  mild  one  you  may)  have 
got  safely  through;  but  again  I  am  not  backing  your  chances.  It  is  the  most 
curious  and  the  most  dangerous  fact  about  sexual  diseases  that  the  symptoms — 
■even  serious  ones — disappear  under  treatment  in  an  incredibly  short  time. 

*  *  * 


LETTEE    TO    A    GODSON  97 

Now  we  will  suppose  that  the  attack  was  not  a  mild  one,  or  that  you  have 
not  applied  proper  remedies,  or  that  you  have  consulted  a  "  quack"  doctor 
advertising  in  one  of  the  lower-class  papers,  or  that  you  have  not  persisted 
long  enough  in  your  treatment.  All  very  reasonable  suppositions.  The  disease 
may  then  turn  into  something  really  serious  and  become  chronic;  that  is,  it 
will  get  a  grip  of  your  system  and  break  out  again  long  after  you  have  imagined 
yourself  fully  cured — even  years  after.  Perhaps  you  may  not  be  able  to  get 
the  discharge  to  dry  up  and  disappear.  From  this  infection  will  possibly  be 
spread  from  soiled  linen,  towels  and  such  like,  and  a  perfectly  innocent  person 
may  contract  the  disease. 

And  if  the  gonorrhoea  becomes  chronic  you  will  not  necessarily  find  the 
original  symptoms  again  attacking  you,  but  a  variety  of  complications  may 
ensue.  For  instance,  there  may  result  a  very  painful  inflammation  of  a  certain 
small  organ  connected  with  the  testicles,  or  perhaps  an  attack  of  a  form  of 
rheumatism,  or,  very  frequent  and  particularly  serious,  you  may  develop 
ophthalmia  and  so  blindness. 

Gonorrhoea  is  very  contagious — you  see  how  easily  you  may  have  con- 
tracted it.  A  man  who  imagines  himself  fully  cured  may  marry,  and  then  he 
will  infect  his  wife.  The  results  with  her  are  infinitely  more  serious.  To 
begin  with,  gonorrhoea  is  known  to  be  one  of  the  most  frequent  and  powerful 
causes  which  prevent  a  woman  having  children.  The  disease  may  also  get 
a  firm  hold  of  certain  internal  organs  and  she  will  have  to  undergo  serious 
operations,  risking  disablement  and  even  life. 


You  must  not  think  that  I  am  selecting  rare  cases  and  telling  you  all  the 
worst  facts  with  the  object  of  frightening  you.  I  only  want  you  to  understand 
that  gonorrhoea  is  indeed  a  serious  thing  which,  supposing  you  ever  contract 
it,  you  must  tackle  the  very  moment  you  think  you  are  infected,  and  persist 
in  treatment  under  skilled  medical  advice  until  you  are  pronounced  absolutely 
cured.  I  am  not  exaggerating  things  one  little  bit;  in  fact  I  am  not  telling  you 
the  worst.  If  you  still  need  convincing  you  should  turn  up  my  little  book, 
"  The  Problem  of  the  Nations." 

I  am  not  going  to  give  you  any  bothering  figures,  but  I  can  assure  you 
that  there  is  no  disease  in  the  world  more  prevalent  than  gononhoea.  I  will 
just  quote  for  you  one  statement  by  an  eminent  man  who  has  made  a  special 
study  of  this  disease,  and  from  that  you  will  see  that  you  are  up  against  a 
really  tough  proposition  : — 

"  It  has  been  established  beyond  doubt  nowadays  that  about  seventy  out 
7 


98  THE    PROBLEM   OF   THE   NATIONS 

of  a  hundred  of  various  serious  diseases  '  *   (which  he  names)   ' '  met  with  in 
married  women  are  due  to  the  infection  of  their  careless,  ignorant  or  unscrupulous 

husbands." 

*  *  * 

Two  words  more  and  then  I  have  done  with  gonorrhoea.  Supposing  that 
you  ever  do  contract  it  you  must  not  necessarily  blame  the  woman,  A  woman 
is  not  attacked  by  the  disease  in  the  same  way  as  a  man,  and,  indeed,  it  is 
very  rare  for  her  to  know  that  there  is  ans^thing  the  matter  with  her.  Even 
medical  men  often  fail  to  diagnose  the  symptoms. 

And  the  other  word  is  this,  although  I  hardly  think  it  necessary  to  say 
it  to  you.  Whatever  any  friend  of  yours  may  remark,  to  have  contracted 
gonorrhoea  is  not  a  sign  of  manhood  and  so  something  to  be  proud  of.  You 
are  an  English  gentleman,  old  fellow,  and  no  gentleman  thinks  cf  women 
like  that. 

Now  I  am  going  to  tell  you  something  about  "  Syphilis,"  the  other  disease 
which  you  may  have  contracted  from  that  one  trivial  adventure  with  a  woman. 
And  as  syphilis  is  really  serious,  unless  you  begin  treatment  right  away  and 
carefully  persist  in  it  for  a  long  time,  I  shall  have  to  say  a  good  deal  about  it. 

The  first  danger  with  syphilis  is  that  you  may  pass  over  as  unimportant  the 
primary  symptoms,  or  first  indication  that  you  are  infected.  You  may  have 
become  pwisoned  by  the  microbe  either  in  the  sexual  act  or,  if  the  woman 
happens  to  be  infected  on  the  lips  or  mouth,  by  kissing  her.  In  any  case  the 
first  symptom  appears  in  about  three  weeks,  a  small,  hard  ulcer,  which  is 
called  a  "  chancre."  This  forms  either  upon  the  genital  organs  or  upon  the 
mouth,  or  indeed  upon  any  part  of  the  body  which  came  in  contact  with  the 
infected  place  upon  the  woman.  The  chancre  is  often  quite  insignificant; 
you  will  take  it  to  be  a  trivial  boil,  perhaps,  and  it  will  gradually  disappear 
with  or  without  any  kind  of  treatment. 

Very  probably  you  will  hear  it  said,  "  Gonorrhoea  is  a  very  ordinary 
complaint,  easily  cured,  but  if  you  get  syphilis  you  might  just  as  well  go  and 
shoot  yourself  right  away."  Those  very  words  were  said  to  me  by  a  young 
fellow  only  last  month;  he  had  got  syphilis  and  was  seriously  proposing  to 
poison  himself.  Even  educated  men  often  think  very  much  the  same,  and, 
what  is  far  worse,  say  it. 

Hugh,  such  an  idea  is  not  only  absolutely  wrong,  it  is  criminal,  and  does 
immense  harm.  Of  the  two  it  is  syphilis  which  is  more  easily  treated.  I  will 
not  say  cured  outright,  because  it  is  rather  a  lengthy  business.     But  I  give 


LETTER   TO   A   GODSON  99 

you  my  word  that  a  case  of  syphilis  can  be  made  non-infective  in  forty-eight 
hours.  If  only  a  man  will  go  straight  to  the  very  best  medical  man  he  can 
find  directly  he  suspects  that  he  is  infected,  and  if  only  he  will  rigidly  follow 
the  advice  and  treatment  given,  then  he  need  not  be  afraid.  It  will  take  time, 
it  may  take  a  couple  of  years  before  he  is  absolutely  cured,  but  he  will  be 
non-infectious  and  the  disease  will   have  been  stopped  from   attacking  other 

parts  of  the  body. 

*  *  * 

But  if  you  neglect  this  advice  and  discontinue  treatment  then  look  out. 
The  next  thing  that  happens  is  the  breaking  out  of  a  particularly  disfiguring 
rash.  You  see  the  poison  has  by  now  begun  to  spread  through  your  body. 
The  rash  generally  indicates  what  are  called  "  secondary  "  symptoms,  but  very 
few  cases  are  exactly  alike.  This  is  the  time  when  the  disease  is  most  con- 
tagious. You  remember  how  careful  they  were  when  you  had  scarlet  fever; 
how  they  separated  you  from  everyone  and  disinfected  everything.  Well,  this 
period  of  syphilis  is  much  the  same.  You  may  give  it  to  anyone  in  all  kinds  of 
unlikely  ways,  by  a  towel,  a  cup,  a  pipe.  A  workman,  for  instance,  may 
become  infected  through  drinking  out  of  the  same  mug  of  beer  which  an 
infected  comrade  has  used.  Then  he,  too,  will  go  through  the  same  course 
of  the  disease,  beginning  with  the  "  chancre." 

I  don't  want  to  horrify  you  too  much,  old  fellow,  but  I  do  want  you  to 
realize  what  is  likely  to  happen  if  you  don't  go  straight  off  to  that  doctor 
and  stick  to  the  treatment.  If  you  stop  the  treatment  the  thing  will  break  out 
worse  than  ever  somewhere  else.  In  some  parts  of  the  world,  particularly 
in  some  country  districts  in  Russia,  syphilis  has  become  an  absolute  plague, 
attacking  every  single  family,  men,  women  and  children.  They  never  get 
treated  properly  because  doctors  are  few,  and  so  the  disease  steadily  spreads 
and  develops  into  other  diseases  which  are  almost  too  dreadful  to  talk  about. 


And  it  is  these  other  diseases,  produced  by  syphilis,  which  give  to  syphilis 
the  evil  reputation  it  has  acquired.  It  is,  I  think,  quite  safe  for  me  to  say 
that  the  "  tertiary  "  symptoms,  or  evil  results,  only  follow  when  there  has 
been  inadequate  treatment  in  the  earlier  stages. 

Well,  then,  if  the  treatment  has  not  been  of  the  proper  kind,  or  if  it  has 
been  stopped  too  soon,  there  is  not  a  single  organ  in  the  body  which  may  not 
be  attacked.  And  the  part  which  is  most  liable  to  attack  is  also,  unfortunately, 
the  most   important  of  all — the  brain,    and   the  nervous   system  generally.     A 


100  THE   PROBLEM   OF   THE   NATIONS 

great  French  specialist  made  careful  notes  upon  4,700  cases  of  these  "  tertiary  " 
symptoms  and,  out  of  all  the  various  parts  of  the  body  affected,  no  fewer  than 
2,009  developed  syphilis  of  the  brain  and  spinal  cord. 

I  could  fill  pages  with  details  of  these  symptoms,  but  I  will  only  most 
earnestly  beg  you  to  weigh  very  carefully  every  word  that  I  have  written,  for 
I  have  not  exaggerated  one  iota.  There  is  not  a  single  organ  in  the  human 
bod})  which  ma])  not  be  attacked  and  destro'^ed  b's  untreated  or  neglected 
syphilis.     And  to  destroy  some  oj  these  organs  means  certain  death. 


Last  of  all  I  must  tell  you  of  the  gravest  of  all  results  of  syphilis — its  effect 
upon  children,  either  by  death  before  or  soon  after  birth,  or  by  the  suffering  to 
which  they  are  condemned  in  life. 

I  don't  want  to  say  much  about  this  side  of  it.  You  will  understand  why. 
It  is  the  last  but  the  strongest  appeal  of  all  to  every  man.  Some  day,  Hugh, 
you  will  meet  a  girl  whom  you  will  love  very  dearly,  who  will  become  all  the 
world  to  you.  She,  too,  will  have  learned  to  love  you  and,  because  she  is 
a  woman,  it  will  be  her  dearest  pride  to  give  into  your  keeping  in  full,  over- 
flowing measure  all  her  pure  soul  and  body. 

This  is,  perhaps,  too  big  a  thing  for  you  to  understand  yet  av/hile,  so  just 
for  the  sake  of  argument  we  will  imagine  that  you  have  begun  to  realize  that 
Miss  Dorothy  means  a  great  deal  more  to  you  than  "  an  awfully  decent  sort  "; 
that  in  fact  you  have  come  to  see  that  she  is  a  very  dear  girl  v/hom,  the 
gods  willing,  you  would  really  like  to  marry. 

Now  supposing  that  as  a  result  of  that  little  adventure  of  yours  you  were 
so  unfortunate  as  to  contract  syphilis.  You  must  not  forget  that  this  would 
have  been  a  very  ordinary  result.  You  might,  had  I  not  now  warned  you,  have 
neglected  to  get  fully  cured  and  so  have  married  Miss  Dorothy  while  in  a  state  of 
infection,  although  believing  yourself  to  be  quite  fit. 


In  the  first  place  you  would  convey  the  poison  into  her  system,  with  all  the 
possible  results  to  her  which  I  have  told  you  of.  Ah,  Hugh,  that  is  not 
pleasant  to  contemplate,  is  it?  The  one  being  in  the  world  whom  you  would 
love  and  cherish  above  all  others.  Then  there  might  be  a  child.  You  love 
children,  Hugh,  and  they,  too,  love  you.     You  should  be  very  proud  of  that. 

A  child  bom  of  syphilitic  parents  is  almost  fatally  condemned  to  death, 
either  before  birth  or  during  the  first  few  days  or  weeks  after  birth.     If  it  lives  it 


LETTER   TO   A   GODSON  101 

grows  up  a  being  apart  from  other  children.  Perhaps,  with  the  stamp  of  years 
of  life  and  suffering  upon  its  little  face  from  the  hour  of  birth,  it  may  grow 
into  a  poor,  wizened  creature,  developing  all  sorts  of  ailments,  never  free  from 
suffering — need  I  go  on,  old  man?  Oh,  you  will  think  of  this,  won't  you! 
For  your  wife's  sake,  for  your  children's  sake,  think.  Is  all  this  worth  an 
hour's  unsatisfied  indulgence?  If  you  must  do  it,  and  the  evil  thing  befals 
you,  then  I  implore  you,  by  all  you  hold  or  may  hold  sacred,  to  face  the 
consequences  like  the  man  you  are  and  not  to  rest  until  you  have  driven  out 
the  last  trace  of  the  poison  from  your  body,  and  you  are  clean    once  more. 

Promise  me,  Hugh  ! 

*  *  -* 

There  are  two  more  points  which  you  may  possibly  think  to  put  to  me. 
You  may  say  that  gonorrhoea  may  be  very  common,  but  that  surely  syphilis 
is  rare.  Again  I  do  not  want  to  give  you  a  lot  of  figures,  but  I  will  just 
take  two  cities  on  either  side  of  the  world  and  tell  you  how  many  cases  of 
syphilis  were  actually  under  medical  treatment  at  a  certain  time. 

In  Melbourne,  out  of  a  population  of  600,000,  and  during  1910-1911, 
there  were  about  3,000  cases.  In  St.  Petersburg,  out  of  a  population  of 
1,620,500  in  1911,  there  were  recorded  45,023  cases  of  syphilis  and  61,355 
cases  of  other  forms  of  sexual  disease,  including  gonorrhoea.  That  will  show 
you  how  prevalent  it  is.  If  I  were  to  tell  you  how  many  young  men  in  Berlin 
or  Paris  contract  these  diseases  you  probably  would  not  believe  me. 


And  the  other  point  might  be  this.  You  may  argue  with  yourself  some- 
what in  this  fashion  :  "  Yes,  I  see  that  there  certainly  is  a  big  risk  if  I  have 
anything  to  do  with  one  of  those  women  of  the  streets.  But  all  those  arguments 
do  not  apply  in  the  case  of  a  girl  who  is  practically  straight  and  earning  her 
living  in  ordinary  business.     She  will  not  have  anything  the  matter  with  her." 

I  am  afraid  that  I  must  dispel  that  illusion  too.  "Practically  straight," 
I  think  you  said.  It  is  just  the  girls  who  are  *'  practically  straight  "  who  are 
the  most  dangerous,  from  the  point  of  view  of  disease.     I  will  tell  you  why. 

The  average  professional  prostitute  knows  well  that  her  prospects  of  trade 
depend  very  largely  upon  keeping  herself  free  from  infection.  She  may  not 
know  that  she  is  in  an  infective  state,  but  she  is  certain  to  take  reasonable 
precautions.  She  is  a  woman  of  experience,  she  knows  what  to  do,  and  she 
realizes  the  value  of  cleanliness.     If  she  neglects  this  she. is  doomed. 

The  "  practically  straight  "  girl  (shall  we  call  her  an  "  amateur  "  prosti- 


102  THE  PROBLEM  OF  THE  NATIONS 

tute?)  is  not  a  woman  of  experience.  Under  the  conditions  in  which  the 
average  girl  of  to-day  is  brought  up  in  this  country  she  is  fairly  certain  to  be 
almost  entirely  ignorant  of  the  most  elementary  facts  of  sex  and  the  functions 
of  her  body.  She  may  not  even  have  heard  of  the  existence  of  sexual  disease; 
and  she  certainly  will  have  very  little  idea  of  putting  into  practice  those 
regular  habits  of  strict  cleanliness  which  her  professional  sister  rightly  regards 
as  a  necessity. 

From  every  country  in  the  world  comes  the  same  report :  "  It  is  not  the 
professional  prostitute  whom  we  fear,  but  the  amateur.  We  can  exercise  some 
control  and  supervision  over  the  former,  we  can  have  none  whatever  over  the 
latter." 

You  seek  for  the  glamour  of  love  over  your  sexual  impulse  and  act.  Ycu 
think  that  you  have  found  it  in  a  girl  who  does  not  expect  payment  in  cash  for 
her  favours.  You  are  wrong.  Once  again  you  are  putting  your  money  on  the 
wrong  horse.  If  it  is  to  the  interest  of  a  professional  to  counterfeit  love,  it  is  still 
more  so  with  an  amateur. 

A  girl  takes  her  first  false  step  through  ignorance  of  the  consequences, 
through  curiosity  to  realize  the  big  thing  of  life,  and,  most  frequently  of  all, 
for  love  of  the  man.  Once  the  act  is  accomplished  the  barrier,  physical  and 
mental,  is  broken  down  and  she  is  an  entirely  different  woman.  You  cannot 
realize  what  that  barrier  is  to  a  girl — very  few  men  can.  Once  it  is  down 
she  is  at  the  mercy  of  the  world.  Her  maidenly  reserve,  innocence  if  you 
will,  is  torn  from  her.  She  has  lost  for  ever  a  great  possession.  The  man 
who  has  taken  it  is  responsible  in  the  sight  of  God  and  men  for  her  future  life. 

Well,  she  has  parted  from  her  first  lover.  She  may  run  straight  afterwards, 
but  it  is  improbable.  The  restraining  influence  has  vanished.  From  her 
experience  of  the  sexual  impulse  she  becomes  reckless  and  other  lovers  follow 
in  succession.  But  a  woman  knows  only  one  real  passionate  love  in  her  life, 
all  the  others  are  merely  shadows.  She  may  seek  to  regain  that  love  in 
another  man,  she  may  have  her  passing  dreams  that  she  has  found  it  once  more — 
they  are  only  dreams. 

And  so  the  comedy  is  played.     She  would  have  each  new  lover  believe 

that  she  is   chaste,  or,    if   the   mask   falls  for   a  moment,    then   "  practically 

straight."     She,  too,  would  throw  the  glamour  of  love  over  the  act.     It  is  a 

mockery;  she  knows  it,  and  you  in  your  heart  know  it.     Believe  me,  old  man, 

it  isn't  worth  it. 

»  *  * 


LETTBB   TO   A   GODSON  103 

You  will  find  your  amateur  prostitute  everywhere.  In  the  chorus  at  the 
Pantheon  Theatre;  behind  the  counter  at  Messrs.  Snip  and  Farthingale's; 
hastening  to  fetch  you  your  toasted  bun  and  pot  of  China  tea  at  that  select 
little  tea-room  in  Threadneedle  Street,  When  you  go  abroad  you  will  find 
her — but  there,  I  could  write  for  you  pages  of  romantic  disguises  which  dis- 
creetly veil  the  amateur.  In  fact,  the  professional  has  long  since  recognized 
the  value  of  these  disguises  in  her  quest  of  trade,  and  it  is  now  exceedingly 
difficult  to  trace  the  dividing  line. 

So  you  see  that  if  you  must  be  on  your  guard  with  the  professional, 
you  must  none  the  less  beware  of  the  amateur.  The  former  is  absolutely 
certain  to  become  infected  sooner  or  later  despite  all  her  precautions;  the  latter 
generally  contracts  the  disease  at  an  early  age,  before  she  is  18  or  19.  Indeed, 
it  is  most  sad  to  think  that  the  majority  of  female  patients  now  being  treated 
in  the  hospitals  for  sexual  disease  are  young  girls  below  the  age  of  20. 

*  *  * 

There,  that  is  all  that  I  am  going  to  say  about  it.  I  have  tried  hard  not 
to  let  you  imagine  that  I  wanted  to  give  you  a  "  pi-jaw  ";  you  won't  think 
that,  will  you,  Hugh?  We,  your  Mother  and  Father  and  I,  desire  your 
happiness  and  good  fortune  more  than  anything  else.  We  want  you  to  turn 
out  what  we  have  tried  to  make  you,  an  English  gentleman  in  the  best  sense  of 
the  word.     We  can  only  lay  the  foundation,  the  rest  is  in  your  hands. 

I  have  told  you  these  things  only  for  your  own  health's  sake  and  that  you 
may  at  least  be  forearmed.  I  once  had  a  dear  friend  who  was  killed  by 
syphilis  simply  because  he  knew  nothing  about  it.  If  you  would  read  the  story 
you  will  find  it  in  that  little  book  of  mine  which  I  have  already  mentioned. 
But  I  swore  then  that  I  would  not  rest  until  I  had  done  what  I  could  to  warn 
others,  to  leave  the  world  a  little  better  than  I  found  it. 

*  *  * 

There  are  now  many  hundreds  of  men  and  women  working  hard  to  stamp 
out  these  diseases  from  civilization.  Syphilis  and  gonorrhoea  are,  in  them- 
selves, no  more  immoral  than  small-pox  or  scarlet  fever.  It  is  not  a  disgraceful 
thing  to  have  contracted  them,  but  a  deep  misfortune. 

And  so  we  would,  if  we  may,  make  the  world  a  more  beautiful  place  to 
live  in.  We  would  win  to  a  finer  and  purer  relationship  between  men  and 
women,  each  living  for  and  with  the  other.  We  would  see  our  children  grow 
into  strong  and  sturdy  citizens  "  of  no  mean  city,"  the  Empire  of  which,  at 
heart,  we  are  so  proud. 


104  THE   PROBLEM   OF   THE   NATIONS 

Perhaps  you  are  going  up  to  Oxford  in  a  year  or  so,  and  of  course  you 
want  to  get  your  cricket  blue.  We  should  be  proud  of  you.  You  won't  get 
it  if  you  go  fooling  around  with  women.  Later,  perhaps,  you  are  going  to 
read  for  the  medical  or  legal  professions.  If  you  spend  evenings  in  a  girl's 
bedroom  your  brain  will  refuse  to  answer  when  you  call  upon  it.  You  will 
find  it  impossible  to  perform  a  delicate  operation,  or  to  plead  a  case  in  Court. 
You  will  not  be  able  to  concentrate. 

If  you  steadily  fight  that  sexual  impulse  you  will  be  incomparably  the  finer 
man  for  it,  in  brain  and  body.  If  ever  you  must  give  way,  then  for  God's 
sake  remember  what  I  have  told  you  :  opav  reXo^,  ,"  look  to  the  end,"  as  old 
Aristotle  said. 

Here  is  a  little  cheque  to  help  you  through  the  Summer  Half. 

Yours  always  affectionately, 

A.  Corbett-SmiTxH, 


105 


A   GLOSSAEY. 

The  definitions  are,  in  nearly  every  case,  taken  from  "  The  Oxford  Dictionary,"  1911. 

Ancemia — Lack  of  blood. 

Aneurysm — The  abnormal  enlargement  of  an  artery ;  and  so  the  gradual 

weakening  of  the  wall  of  the  vessel  through  the  blood  pressure. 
Aorta — The  great  artery,  or  trunk  of  the  arterial  system  issuing  from 

the  left  ventricle  of  the  heart. 
Congenital — Belonging  to  an  individual  from  birth. 
Contagious — Communicating  disease  by  contact,  cf.  infectious. 
Embryo — The  child  in  the  womb  before  birth. 
Endemic — Eegularly  found  in  a  community,  cf.  epidemic. 
Epidemic — Prevalent  in  a  community  at  a  special  time,  cf.  endemic. 
Fcetus — The  fully  developed  embryo  in  the  womb. 
Qleet — Thin  morbid  discharge  from  the  urethra. 
Gynecology — The  science  of  the  diseases  of  women. 
Infectious — Communicating  disease  by  air  or  water,  cf.  contagious. 
Locomotor  Ataxy — Constitutional  unsteadiness  in  the  use  of  the  arms, 

legs,  &c. 
Mucous  Membrane — The  internal  skin  covered  with  the  slimy  secretion 

of  the  body. 
Ovaries — The  reproductive  organs  in  the  female  in  which  the  ova  are 

produced. 
Parturition — Childbirth. 
Pathogenic — Productive  of  disease. 
Pathology — The  science  of  diseases. 
Prostate — A   glandular   body   situated   around   the  neck  of   the  bladder 

in  the  male. 
Rickets — Children's  disease,  with  softening  of   the  bones,  especially  the 

spine. 
Suppurative — Tending  to  fester. 
Tabes — Wasting  disease  of  the  spinal  cord. 

Urethra — The  canal  by  which  urine  is  discharged  from  the  bladder. 
Uterus — The  womb. 

Vagina — The   sexual   passage    in   the   female    from    the   uterus    to    the 
external  orifice. 


106 


INDEX. 


Aboetion,  44 

Alcohol  (a  factor  in  disease),  7,  66,  80,  86,  95 

Alien  immigration,  78 

Anaemia,  26 

Aneurysm,  30 

Aortic  disease,  32 

Army  (British),  7,  13,  63,  64,  75,  81 

— ,  German,  72,  73,  87 

—  ,  Japanese,  12,  67 

Australia,  49,  65 

Bennie,  Dr.  (quoted),  49 

Berlin,  13,  16,  66,  71-73,  78 

Blaschko,  Professor  (quoted),  72 

Blindness,  3,  20,  21,  22,  30,  50 

Boy  scouts,  7,  88 

Brieux  (quoted),  55 

Bright 's  disease,  33 

Brock,  B.  G.,  65 

Browning,  Dr.  Carl  H.,  31,  32 

Bucharest,  70,  74,  78 

Bulkley,  Dr.  Duncan  (quoted),  58 

Canceb,  30 

Central  Asia  (Russian),  69 

Chancre,  simple,  10 

— ,  syphilitic,  25,  58,  98 

Children,  infection  of,  45-54,  84,  100 

China,  41,  65 

Christiania,  64,  70,  74,  77,  78 

Contagion,  innocent,  14,  15,  19,  24,  28,  32, 

37-61,  70,  84 
— ,  "mediate,"  59,  99 
— ,  mixed,  maternal  and  paternal,  46-48 
—  through  industrial  employment,  59,  60 
Convulsions,  53 
Copenhagen,  71,  74,  78,  82 

Deafness,  31,  33,  50 
Dublin,  50 

Education  of  the  individual,  4,  7,  8, 14,  22, 

25,  33,  34,  36,  41,  44,  51,  57,  85-89 
Ehrlich,  Professor  P.,  viii,  5,  57,  83 
England  and  Wales,  49-51,  75,  81,  82 
English  Review,  The,  2 
Epididymitis,  18 
Epilepsy,  31,  33 


Eye  diseases,  32 

POURNIBR,  Professor  Alfred  (quoted),  17,  18, 

19,  21,  24,  25,  26,  27,  39 
Eraser,  Dr.  Kate  (quoted),  53 
French,  Major  H.  C.  (quoted),  49 

Germany,  64,  71-73 

Gibbard,  Colonel  T.  W.  (quoted),  57 

Glass  blowing,  59 

Gleet,  15,  18 

Goldwin,  Dr.  (quoted),  68 

Gonorrhoea,  chronic,  11,  19,  22 

— ,  definition  of,  10 

— ,  history  of,  10 

— ,  ignorance  of  symptoms,  18,  93 

— ,  pathology  of,  18 

— ,  prevalence  (general)  of,  15,  16,  22 

— ,  prevalence  oi,  versus  syphilis,  12,  15,  22, 

82,  98  {see  also  under  names  of  countries 

and  cities) 
— ,  quack  treatment  of,  17,  97 
— ,  statistics  (inadequate)  of,  17 
— ,  symptoms  of,  10,  11,  96 
— ,  treatment  of,  18,  22 
Gout,  33 
Guinaud,  Dr.  (quoted),  59 

Ham,  Dr.  B.  Burnett,  viii,  15,  64 
Harrison,  Major  W.  S.  (quoted),  83 
Hata,  Professor  S.,  viii,  5,  6,  57,  68,  83 
Heart  diseases,  31,  52 
Heredity,  28,  29,  32,  43,  45-54 
Hochringer,  Dr.  (quoted),  48 
Hutchinson,  Sir  Jonathan  (quoted),  32,  58 
Hygiene,  sexual,  54,  79,  87,  88 

Industrial  employment,  59,  60 
Infantile  mortality,  46-51,  60,  100 
Inflammation  of  bladder,  19 

—  kidneys,  19 

—  prostate,  21 

—  spine,  19,  27 
Illegitimate  infants,  51 
Insanity,  3,  8,  29,  31,  53,  63 
Ireland,  50 

Japan,  12,  63,  66-68,  74 


INDEX 


107 


Jeanselme,  Dr.  (quoted),  51,  84 
Johnson,  J,  Taber  (quoted),  15 

"  Kiss  in  the  ring,"  41,  58 

Lane,  J.  Ernest  (quoted),  39 

Laryngitis,  33,  51 

Ledermann,  Dr.  R.  (quoted),  41 

Leroux,  Dr.  (quoted),  48 

Life  Assurance,  43 

Liver,  32 

Local     Government     Board,     Report     on 

Venereal  Diseases,  2,  14,  38,  64,  75 
London,  66,  76,  78,  81,  82 
Love,  Dr.  J.  Kerr  (quoted),  33,  50 
Luys,  Dr.  Georges  (quoted),  10,  15,  97 

MacGillivray,  Dr.  C.  W.  (quoted),  44 
Marriage  and  syphilis,  42-44,  60,  84,  100 
Marshall,  Dr.  0.  P.  (quoted),  24,  29,  45,  46, 

47,  52 
Melbourne,  64,  65,  74,  76,  77,  78,  82,  101 
Melville,  Colonel  C.  H.,  viii,  15 
Midwives,  58 

Morrow,  Dr.  A.  Prince  (quoted),  69 
Moscow,  49,  69,  73,  77,  78 

Navy  (British),  13,  75,  81 
— ,  Japanese,  68 
—  of  U.S.A. ,69 
Neisser,  Professor,  10,  15 
Nervous  system,  27,  32,  99 
New  York  City,  64,  68,  74,  78 
Noeggerath,  Dr.  (quoted),  15 
Northern  Africa,  65 
Nurses,  55-57 

Ophthalmia,  3,  8,  11,  14,  19,  20,  21,  22,  26 
Osier,  Sir  William  (quoted),  28,  30 
Ozoena,  32 

Paralysis,  19,  29,  33 

Paris,  48,  51,  66 

Philadelphia,  41,  58 

Pinard,  Dr.  (quoted),  55 

Pinkus,  Prof,  (quoted),  72 

Pontopiddan,  Prof.  Erik  (quoted),  71 

Prostitution,  professional,  4,  6,  15,  66,  73, 

78,  80,  95 
— ,  amateur,  4,  36,  60,  66,  101-3 

"  Retribution,  Just,"  38,  61,  84 
Rheumatism,  19,  21 


Rickets,  33,  51,  53 

Roumania,  41,  70,  73,  74 

Royal  Commission  on  Venereal  Diseases, 

3,  4,  51,  64 
Russia,  49,  64,  69,  70,  73,  99 

St.  Petersburg,  69,  73,  77,  78,  101 

Salvarsan,  ("  606),"  5,  57,  83 

Sayer,  Dr.  Ettie,  3 

Sequeira,  Dr.  J.  H.  (quoted),  52 

Shanghai,  80 

Siberia,  69,  73 

South  Africa,  65 

South  America,  41,  64,  77 

Sterility,  14,  19,  22,  44 

Stevenson,  Dr.  T.  H.  C,  40 

Syphilis,  chronic  nature  of,  24,  25 

— ,  congenital,  46,  47 

— ,  definition  of,  24 

— ,  general  prevalence  of,   40,  49  (see  also 

under  names  of  countries  and  cities) 
— ,  history  of,  23 

— ,  ignorance  of  symptoms,  25,  40,  42,  98 
— ,  prevalence  of,  versus  gonorrhoea,  12,  15, 

42,98 
— ,  quack  treatment  of,  42 
— ,  statistics,   28,   32,   62  (see  also   under 

countries  and  cities) 
— ,  symptoms  of,  25,  26 

,  primary,  25,  35,  57,  98 

,  secondary,  26,  35,  57,  99 

,  tertiary,  26,  27,  36,  99 

— ,  treatment  of,  17,  26,  43,  44,  51,  83,  84, 

99 
— ,  ubiquity  of,  24,  27 

Tabes,  28 

Tarnowski,  Dr.  (quoted),  49,  70 
Teeth  diseases,  33,  52 
Tuberculosis,  29,  33,  44,  51 

Urethra,  10,  21 

Victoria,  64 
Vienna,  48 

Was^ermann  Test,  30,  31,  32,  53,  64,  68 
Watson,  Dr.  H.  Ferguson  (quoted),  53 
Wechselbaum,  Prof,  (quoted),  83 
White,  Dr.  J.  Douglas  C.  (quoted),  15,  82 
Women's  movement,  5,  12,  16,  17,  79 

ZULULAND,    65 


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